Healthcare Provider Details

I. General information

NPI: 1407629421
Provider Name (Legal Business Name): SCOT WILLIAM BRUCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S LAPEER RD
OXFORD MI
48371-6106
US

IV. Provider business mailing address

5480 ABBY COURT RD
DRYDEN MI
48428-0529
US

V. Phone/Fax

Practice location:
  • Phone: 248-969-9375
  • Fax:
Mailing address:
  • Phone: 586-482-2585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: