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NPI Code Detail

MEDICARE: DR. BRUCE KEVIN WAITE D.O.

MEDICARE:  DR. BRUCE KEVIN WAITE  D.O.
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
1207V00000XObstetrics & Gynecology PhysicianDO1972ME
2207V00000XObstetrics & Gynecology PhysicianDO17052OR
3207V00000XObstetrics & Gynecology Physician62771MN

Other Identifiers

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

General Provider Information

NPI Number : 1851394530
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE KEVIN WAITE D.O.
Provider Business Mailing Address
First Line : 404 W. FOUNTAIN ST
Second Line :
City : ALBERT LEA
State : MN
Zip : 56007-2437
Country : US
Telephone Number : 507-373-2384
Fax Number : 507-668-2975
Provider Business Practice Location Address
First Line : 1000 FIRST DR NW
Second Line :
City : AUSTIN
State : MN
Zip : 55912-2941
Country : US
Telephone Number : 507-433-7351
Fax Number : 507-668-2975
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 07/21/2022

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Directions to “ DR. BRUCE KEVIN WAITE D.O.” Practice Location

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