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General NPI Number Information
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NPI Number | 1295711901
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Entity Type | Individual
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Provider Name | GORDON BRUCE MD
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Gender | Male
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 3320 LIVE OAK ST COPC ADMINISTRATION
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City | DALLAS
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State | TX
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Zip | 75204-6109
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Country | US
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Telephone | 214-266-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 660599
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City | DALLAS
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State | TX
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Zip | 75266-0599
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | J4011
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | J4011
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License Number State | TX
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