MEDICARE: DR. BRUCE ALLAN GUEBARD 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	207Q00000X	Family Medicine Physician	01027774A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00698414	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000595574	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881709608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ALLAN GUEBARD M.D.

Provider Business Mailing Address
First Line	:	1234 E DUPONT RD
Second Line	:	SUITE1
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1545
Country	:	US
Telephone Number	:	260-373-9700
Fax Number	:	260-373-9740

Provider Business Practice Location Address
First Line	:	5104 N CLINTON ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-5720
Country	:	US
Telephone Number	:	260-422-2481
Fax Number	:	260-969-3067

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	03/26/2013

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