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General NPI Number Information
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NPI Number | 1033268917
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Entity Type | Individual
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Provider Name | DEAN ELMER BRUCE M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1501 SAN PEDRO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5153
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Country | US
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Telephone | 505-265-1711
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Fax |
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Provider Business Mailing Address
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Address Line | 1832 GEORGIA ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-5903
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Country | US
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Telephone | 505-255-2978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A95036
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License Number State | CA
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