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NPI Code Detail

MEDICARE: DR. ANDREA MAUREEN BRUCE D.O.

MEDICARE: DR. ANDREA MAUREEN BRUCE D.O.
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
1207Q00000XFamily Medicine Physician17397MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295739894
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREA MAUREEN BRUCE D.O.
Provider Business Mailing Address
First Line : PO BOX 2499
Second Line :
City : COLLINS
State : MS
Zip : 39428-2499
Country : US
Telephone Number : 601-765-3180
Fax Number : 601-765-2808
Provider Business Practice Location Address
First Line : 701 S HOLLY AVE
Second Line :
City : COLLINS
State : MS
Zip : 39428-3894
Country : US
Telephone Number : 601-765-3180
Fax Number : 601-765-2808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 03/07/2023

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