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General NPI Number Information
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NPI Number | 1306166152
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Entity Type | Individual
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Provider Name | ELIZABETH REBECCA GEDDES-BRUCE M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 3637 FAR WEST BLVD STE E
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City | AUSTIN
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State | TX
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Zip | 78731-4126
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Country | US
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Telephone | 512-615-2737
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Fax | 512-379-7204
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Provider Business Mailing Address
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Address Line | 3637 FAR WEST BLVD STE E
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City | AUSTIN
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State | TX
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Zip | 78731-4126
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Country | US
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Telephone | 512-615-2737
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Fax | 512-379-7204
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | Q0259
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License Number State | TX
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