MEDICARE: DR. TRAVIS O BRUCE 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	2084P0800X	Psychiatry Physician	23877	SC

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	:	1831150440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRAVIS O BRUCE M.D.

Provider Business Mailing Address
First Line	:	2817 ROCK MERRITT AVE BLDG 4-3219 RM G117
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:	910-570-3048
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ROCK MERRITT AVE BLDG 4-3219
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-4613
Country	:	US
Telephone Number	:	105-703-0489
Fax Number	:

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	10/01/2024

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