Provider Demographics
NPI:1043648967
Name:BRUCE, SIMON RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:RICHARD
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 1:5658 SHASTA DAISY TRL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6972
Mailing Address - Country:US
Mailing Address - Phone:858-531-5977
Mailing Address - Fax:
Practice Address - Street 1:5658 SHASTA DAISY TRL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6972
Practice Address - Country:US
Practice Address - Phone:858-531-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38121207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism