Healthcare Provider Details

I. General information

NPI: 1942267281
Provider Name (Legal Business Name): KAREN H BRUCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 S 5TH ST
COLLINS MS
39428-4147
US

IV. Provider business mailing address

415 S 28TH AVE
HATTIESBURG MS
39401-7246
US

V. Phone/Fax

Practice location:
  • Phone: 601-765-4414
  • Fax: 601-765-9141
Mailing address:
  • Phone: 601-765-4414
  • Fax: 601-579-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18675
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: