Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 38121 | MN |
NPI | 1043648967 |
---|---|
Provider Name | Dr. Simon Richard Bruce |
First Address | San Diego, CA 92130-6972 |
Second Address | San Diego, CA 92130-6972 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2013 |
Last Update Date | 31/10/2013 |