Healthcare Provider Details

I. General information

NPI: 1003573593
Provider Name (Legal Business Name): JANIE LEATHERS BRUCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANIE MARIE LEATHERS

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65201-5276
US

IV. Provider business mailing address

1 HOSPITAL DR
COLUMBIA MO
65201-5276
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-1767
  • Fax:
Mailing address:
  • Phone: 573-882-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2026016384
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2025020967
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: