Provider Demographics
NPI:1093826521
Name:SAND, BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:SAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W BERYL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-1606
Mailing Address - Country:US
Mailing Address - Phone:602-439-6780
Mailing Address - Fax:602-467-4733
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:SUITE 139
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:602-996-8888
Practice Address - Fax:602-992-2280
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1841207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z1370OtherHEALTHNET
AZ232380Medicaid
AZAZ0068280OtherBCBS
AZAZ0068280OtherBCBS
AZ1Z1370OtherHEALTHNET
AZE20683Medicare UPIN