Provider Demographics
NPI:1154315174
Name:WERBER, BRUCE R (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:R
Last Name:WERBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4782 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1955
Mailing Address - Country:US
Mailing Address - Phone:602-750-1146
Mailing Address - Fax:888-232-6750
Practice Address - Street 1:9188 E SAN SALVADOR DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5562
Practice Address - Country:US
Practice Address - Phone:602-405-3247
Practice Address - Fax:888-232-6750
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM00200213E00000X
AZ624213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI21286-7OtherB/C & B/S OF RI
RI7005207Medicaid
RI002385OtherBLUE CHIP
AZ961202Medicaid
RI002385OtherBLUE CHIP
RI7005207Medicaid