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NPI Code Detail

MEDICARE: DR. WILLIE BRUCE DO

MEDICARE: DR. WILLIE BRUCE DO
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
1207P00000XEmergency Medicine Physician036-081683IL
2207P00000XEmergency Medicine PhysicianDO3108NV
3207P00000XEmergency Medicine PhysicianOS8626FL

General Provider Information

NPI Number : 1336139328
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIE BRUCE DO
Provider Business Mailing Address
First Line : 1800 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-2386
Country : US
Telephone Number : 702-383-2000
Fax Number :
Provider Business Practice Location Address
First Line : 5755 E CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89142-1004
Country : US
Telephone Number : 702-383-6240
Fax Number : 702-224-7186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 01/07/2026

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Directions to “ DR. WILLIE BRUCE DO” Practice Location

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