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General NPI Number Information
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NPI Number | 1689732372
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Entity Type | Individual
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Provider Name | BRUCE A. JENNE P.T.
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 430 W MAIN ST STE 1
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City | DOTHAN
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State | AL
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Zip | 36301-1616
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Country | US
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Telephone | 334-794-0507
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Fax |
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Provider Business Mailing Address
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Address Line | 604 OVERLOOK DR
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City | DOTHAN
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State | AL
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Zip | 36303-1337
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Country | US
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Telephone | 334-702-1577
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PTH2193
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License Number State | AL
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