MEDICARE: DR. BRUCE G MACDONALD 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	207Q00000X	Family Medicine Physician	MD00013750	WA

General Provider Information

NPI Number	:	1548233893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE G MACDONALD MD

Provider Business Mailing Address
First Line	:	1329 KAMUS WAY FI
Second Line	:
City	:	FOX ISLAND
State	:	WA
Zip	:	98333-9639
Country	:	US
Telephone Number	:	253-549-2302
Fax Number	:

Provider Business Practice Location Address
First Line	:	1329 KAMUS WAY FI
Second Line	:
City	:	FOX ISLAND
State	:	WA
Zip	:	98333-9639
Country	:	US
Telephone Number	:	253-549-2302
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	11/16/2009

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