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General NPI Number Information
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NPI Number | 1578962122
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE ASSOCIATES
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 1121 HIGHWAY 35 N
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City | ROCKPORT
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State | TX
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Zip | 78382-3112
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Country | US
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Telephone | 361-729-5388
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Fax | 361-729-5917
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Provider Business Mailing Address
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Address Line | PO BOX 1209
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City | ARANSAS PASS
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State | TX
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Zip | 78335-1209
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Country | US
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Telephone | 361-729-5388
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Fax | 361-729-5917
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | RONALD W BRUCE
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Credential | D.O.
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Telephone | 361-729-5388
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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 | G8675
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License Number State | TX
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