Provider Demographics
NPI:1013228907
Name:BRUCE, TIMOTHY PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PETER
Last Name:BRUCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4W22370 BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1683
Mailing Address - Country:US
Mailing Address - Phone:414-439-3000
Mailing Address - Fax:
Practice Address - Street 1:6002 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4524
Practice Address - Country:US
Practice Address - Phone:414-439-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070075A207PE0005X
IL125.068486208200000X
390200000X
WI80034-20208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program