Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | MA52793 | FL |
Y | 175L00000X | Homeopath | MA52793 | FL |
NPI | 1609100080 |
---|---|
Provider Name | Mr. Douglas Brian Bruce |
First Address | Pensacola, FL 32501-3442 |
Second Address | Pensacola, FL 32503-4717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2009 |
Last Update Date | 01/10/2009 |