MEDICARE: DR. BRUCE J DREYFUSS M.D.

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	207RR0500X	Rheumatology Physician	G64297	CA
2	2471B0102X	Bone Densitometry Radiologic Technologist	RHC142268	CA
3	261QR0200X	Radiology Clinic/Center	FAC52131	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	660003967	OTHER	CA	RAILROAD MEDICARE
3	110048492	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ZZZ54863Z	OTHER	CA	BLUE SHIELD #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558366047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE J DREYFUSS M.D.

Provider Business Mailing Address
First Line	:	25 N 14TH ST
Second Line	:	STE 890
City	:	SAN JOSE
State	:	CA
Zip	:	95112-6216
Country	:	US
Telephone Number	:	408-288-6623
Fax Number	:	408-288-6698

Provider Business Practice Location Address
First Line	:	25 N 14TH ST
Second Line	:	STE 890
City	:	SAN JOSE
State	:	CA
Zip	:	95112-6216
Country	:	US
Telephone Number	:	408-288-6623
Fax Number	:	408-288-6698

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	02/05/2009

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