MEDICARE: BRUCE SUCKLING 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	207RP1001X	Pulmonary Disease Physician	057328	GA
2	207RP1001X	Pulmonary Disease Physician	46262	CO

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	:	1891749495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE SUCKLING M.D.

Provider Business Mailing Address
First Line	:	1725 E BOULDER STREET, SUITE 204
Second Line	:	PULMONARY ASSOCIATES
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5756
Country	:	US
Telephone Number	:	719-471-1069
Fax Number	:	719-577-4828

Provider Business Practice Location Address
First Line	:	1725 E BOULDER STREET, SUITE 204
Second Line	:	PULMONARY ASSOCIATES
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5756
Country	:	US
Telephone Number	:	719-417-1909
Fax Number	:	719-447-0425

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/16/2009

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Directions to “ BRUCE SUCKLING M.D.” Practice Location

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