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NPI Code Detail

MEDICARE: DR. DAVID BRUCH

MEDICARE: DR. DAVID BRUCH
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
1183500000XPharmacist3358WY

General Provider Information

NPI Number : 1629688445
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID BRUCH
Provider Business Mailing Address
First Line : 5419 SUMMIT DR
Second Line :
City : LARAMIE
State : WY
Zip : 82070-5738
Country : US
Telephone Number : 307-766-6064
Fax Number :
Provider Business Practice Location Address
First Line : 3112 E GRAND AVE
Second Line :
City : LARAMIE
State : WY
Zip : 82070-5141
Country : US
Telephone Number : 307-745-7246
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2020
Last Update Date : 08/06/2020

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Directions to “ DR. DAVID BRUCH ” Practice Location

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