Provider Demographics
NPI:1083611792
Name:BRUCE, DAVID E (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:BRUCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7740 WASHINGTON VILLAGE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3994
Mailing Address - Country:US
Mailing Address - Phone:937-439-4145
Mailing Address - Fax:937-439-4371
Practice Address - Street 1:7740 WASHINGTON VILLAGE DR STE 110
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3994
Practice Address - Country:US
Practice Address - Phone:937-439-4145
Practice Address - Fax:937-439-4371
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-002357208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0405494Medicaid
OH0468174Medicare PIN
OHC01726Medicare UPIN