Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01068988A | IN |
Y | 208600000X | Surgeon | 01068988A | IN |
NPI | 1003044520 |
---|---|
Provider Name | Dr. Sidney D Bruce |
First Address | Muncie, IN 47303-4988 |
Second Address | Lafayette, IN 47905-8764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300025350 | (05) | IN |