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General NPI Number Information
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NPI Number | 1295739894
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Entity Type | Individual
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Provider Name | ANDREA MAUREEN BRUCE D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 701 S HOLLY AVE
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City | COLLINS
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State | MS
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Zip | 39428-3894
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Country | US
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Telephone | 601-765-3180
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Fax | 601-765-2808
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Provider Business Mailing Address
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Address Line | PO BOX 2499
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City | COLLINS
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State | MS
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Zip | 39428-2499
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Country | US
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Telephone | 601-765-3180
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Fax | 601-765-2808
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17397
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License Number State | MS
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