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General NPI Number Information
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NPI Number | 1700159548
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Entity Type | Organization
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Legal Business Name | BRUCE B CHISHOLM MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 39300 BOB HOPE DR BANNAN BLDG SUITE 1208
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-7088
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Country | US
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Telephone | 760-779-9559
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Fax |
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Provider Business Mailing Address
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Address Line | 39300 BOB HOPE DR BANNAN BLDG SUITE 1208
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-7088
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Country | US
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Telephone | 760-779-9559
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRUCE B CHISHOLM
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Credential | M.D.
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Telephone | 760-779-9559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G81937
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | G81937
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License Number State | CA
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