Doctor Name: | MARVIN HUBERT BRUCE |
NPI Number: | 1568717866 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | C0001182 |
Business Practice Address: | 1711 Albert Ter Mitchellville, MD - 207212202 |
Business Phone Number: | 3012493665 |
Business Fax Number: | |
Mailing Address: | 1711 Albert Ter, MITCHELLVILLE |
State: | MD |
Postal Code: | 207212202 |
Phone Number: | 3012493665 |
Fax Number: | |
NPI Enumeration Date: | 07/23/2012 |
NPI Last Update Date: | 07/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | C0001182 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |