Healthcare Provider Details

I. General information

NPI: 1265423255
Provider Name (Legal Business Name): BRUCE E. HENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 3RD ST
DULUTH MN
55805-1951
US

IV. Provider business mailing address

400 E 3RD ST
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-3029
  • Fax: 218-786-3416
Mailing address:
  • Phone: 218-786-3029
  • Fax: 218-786-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number50000
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: