Healthcare Provider Details

I. General information

NPI: 1932175106
Provider Name (Legal Business Name): BRUCE N WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 SE COMBS FLAT RD
PRINEVILLE OR
97754-2562
US

IV. Provider business mailing address

PO BOX 7287
BEND OR
97708-7287
US

V. Phone/Fax

Practice location:
  • Phone: 541-447-6263
  • Fax: 541-447-8724
Mailing address:
  • Phone: 541-447-6263
  • Fax: 541-447-4698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD14210
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: