Provider Demographics
NPI:1033250113
Name:DAVIES, BRUCE GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:GERARD
Last Name:DAVIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1033 REGENTS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6045
Mailing Address - Country:US
Mailing Address - Phone:253-564-1115
Mailing Address - Fax:253-565-4552
Practice Address - Street 1:1033 REGENTS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6045
Practice Address - Country:US
Practice Address - Phone:253-564-1115
Practice Address - Fax:253-565-4552
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA29377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1073998Medicaid
WAAB18503Medicare ID - Type Unspecified