Provider Demographics
NPI:1073502944
Name:ENSIGN, BRUCE GENTRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:GENTRY
Last Name:ENSIGN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5909
Mailing Address - Country:US
Mailing Address - Phone:907-729-1234
Mailing Address - Fax:907-729-1226
Practice Address - Street 1:4000 AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5909
Practice Address - Country:US
Practice Address - Phone:907-729-1234
Practice Address - Fax:907-729-1226
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13012207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology