Healthcare Provider Details

I. General information

NPI: 1356323448
Provider Name (Legal Business Name): ROBERT GRADY BRUCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16040 PARK VALLEY DR STE 111
ROUND ROCK TX
78681-3596
US

IV. Provider business mailing address

8240 N MOPAC EXPY STE 100
AUSTIN TX
78759-8869
US

V. Phone/Fax

Practice location:
  • Phone: 512-248-2200
  • Fax: 512-248-1950
Mailing address:
  • Phone: 512-687-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberJ6357
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: