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General NPI Number Information
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NPI Number | 1417069105
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Entity Type | Individual
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Provider Name | SAMUEL L BRUCE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10 CONGRESS ST STE #511
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City | PASADENA
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State | CA
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Zip | 91105-3023
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Country | US
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Telephone | 626-796-0360
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Fax | 626-796-0634
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Provider Business Mailing Address
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Address Line | PO BOX 50766
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City | PASADENA
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State | CA
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Zip | 91115-0766
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Country | US
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Telephone | 626-796-0360
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Fax | 626-796-0634
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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 | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | G292231
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License Number State | CA
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