Healthcare Provider Details

I. General information

NPI: 1306583620
Provider Name (Legal Business Name): BRUCE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MACGREGOR PINES DR STE 109
CARY NC
27511-6037
US

IV. Provider business mailing address

160 MACGREGOR PINES DR STE 310A
CARY NC
27511-6036
US

V. Phone/Fax

Practice location:
  • Phone: 919-609-6388
  • Fax:
Mailing address:
  • Phone: 919-390-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY FRATELLO III
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 919-390-2848