MEDICARE: BRUCE ARTHUR LESSEY 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	207V00000X	Obstetrics & Gynecology Physician	23592	SC
2	207VE0102X	Reproductive Endocrinology Physician	23592	SC
3	207VE0102X	Reproductive Endocrinology Physician	29614	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1477509263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE ARTHUR LESSEY MD

Provider Business Mailing Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 MILLER ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2508
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	01/30/2019

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