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NPI Code Detail

MEDICARE: MR. BRUCE WHITWELL P.A.

MEDICARE: MR. BRUCE WHITWELL P.A.
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
1363A00000XPhysician AssistantPA04646TX

General Provider Information

NPI Number : 1255405379
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE WHITWELL P.A.
Provider Business Mailing Address
First Line : 3515 RICHMOND RD
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-0711
Country : US
Telephone Number : 903-791-9355
Fax Number : 903-831-7273
Provider Business Practice Location Address
First Line : 3515 RICHMOND RD
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-0711
Country : US
Telephone Number : 903-791-9355
Fax Number : 903-831-7273
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 05/07/2014

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Directions to “ MR. BRUCE WHITWELL P.A.” Practice Location

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