Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | M7881 | TX |
NPI | 1073587929 |
---|---|
Provider Name | Dr. Erik Jude Bruce |
First Address | Hutto, TX 78634-3121 |
Second Address | Round Rock, TX 78665-8003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 17/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1579181 | (05) | LA |
I23555 | (02) |