MEDICARE: DR. BRUCE C MCALLISTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G79679	CA
2	207RH0003X	Hematology & Oncology Physician	2819611205	UT
3	2085R0001X	Radiation Oncology Physician	281961-1205	UT

General Provider Information

NPI Number	:	1144223835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE C MCALLISTER MD

Provider Business Mailing Address
First Line	:	1055 N 500 W
Second Line	:	CREDENTIALING DEPARTMENT
City	:	PROVO
State	:	UT
Zip	:	84604-3305
Country	:	US
Telephone Number	:	801-354-8225
Fax Number	:	801-418-0941

Provider Business Practice Location Address
First Line	:	1055 N 500 W
Second Line	:	SUITE 102
City	:	PROVO
State	:	UT
Zip	:	84604-3305
Country	:	US
Telephone Number	:	801-374-2367
Fax Number	:	801-429-0600

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/27/2023

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