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General NPI Number Information
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NPI Number | 1366670200
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Entity Type | Organization
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Legal Business Name | BRUCE S BARBOUR, MD
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 900 E MICHIGAN AVE
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City | JACKSON
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State | MI
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Zip | 49201-2457
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Country | US
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Telephone | 517-787-1995
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Fax | 517-789-8657
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Provider Business Mailing Address
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Address Line | 900 E MICHIGAN AVE
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City | JACKSON
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State | MI
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Zip | 49201-2457
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Country | US
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Telephone | 517-787-1995
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Fax | 517-789-8657
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Authorized Official
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Title or Position | OWNER
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Name | BRUCE BARBOUR
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Credential | MD
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Telephone | 517-787-1995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301053463
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License Number State | MI
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