Provider Demographics
NPI:1114020906
Name:BRUCE, JAMES ALVIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALVIN
Last Name:BRUCE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5310 HIGHWAY 25
Mailing Address - Street 2:STE 5
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-6148
Mailing Address - Country:US
Mailing Address - Phone:601-939-0079
Mailing Address - Fax:601-939-6823
Practice Address - Street 1:2500 LAKELAND DR
Practice Address - Street 2:STE A
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232
Practice Address - Country:US
Practice Address - Phone:601-939-0079
Practice Address - Fax:601-939-6823
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2018-01-23
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Provider Licenses
StateLicense IDTaxonomies
MS05768207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00015790Medicaid
MS00015790Medicaid
B30785Medicare UPIN