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General NPI Number Information
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NPI Number | 1407894041
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Entity Type | Organization
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Legal Business Name | BRUCE C MCCOMAS, M. D., P. A.
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 03/09/2013
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Provider Practice Location Address
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Address Line | 775 POLE LINE RD W SUITE 212
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City | TWIN FALLS
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State | ID
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Zip | 83301-5814
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Country | US
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Telephone | 208-814-8400
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Fax | 208-734-3045
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Provider Business Mailing Address
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Address Line | PO BOX 587
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City | TWIN FALLS
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State | ID
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Zip | 83303-0587
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Country | US
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Telephone | 208-814-7400
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Fax | 208-814-7491
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Authorized Official
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Title or Position | PHYSICIAN
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Name | BRUCE C MCCOMAS
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Credential | M.D.
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Telephone | 208-734-3596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M5070
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License Number State | ID
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