Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD025148E | PA |
NPI | 1003954413 |
---|---|
Provider Name | Dr. Bruce Barris |
First Address | Broomall, PA 19008-3748 |
Second Address | Broomall, PA 19008-3748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B34620 | (02) | PA |