MEDICARE: BRUCE FLAGG 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
1	208D00000X	General Practice Physician	R20A5309	CA

General Provider Information

NPI Number	:	1457627853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE FLAGG D.O.

Provider Business Mailing Address
First Line	:	2041 POLK ST
Second Line	:	SUITE E
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-2525
Country	:	US
Telephone Number	:	650-898-7604
Fax Number	:	650-851-0931

Provider Business Practice Location Address
First Line	:	2041 POLK ST
Second Line	:	SUITE E
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-2525
Country	:	US
Telephone Number	:	650-898-7604
Fax Number	:	650-851-0931

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

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/27/2013

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