Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 49850 | TN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 49850 | TN |
NPI | 1073711677 |
---|---|
Provider Name | Dr. Jeremy Reginald Bruce |
First Address | Chattanooga, TN 37421-7185 |
Second Address | Chattanooga, TN 37403-2103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2007 |
Last Update Date | 08/10/2015 |