Provider Demographics
NPI:1164423067
Name:BRUCE, COREY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:SCOTT
Last Name:BRUCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 E CAMELBACK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3913
Mailing Address - Country:US
Mailing Address - Phone:602-422-9000
Mailing Address - Fax:602-556-5951
Practice Address - Street 1:530 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3204
Practice Address - Country:US
Practice Address - Phone:602-351-2229
Practice Address - Fax:602-351-1500
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29104207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4872600OtherCIGNA PROVIDER ID
AZ1Z5857OtherHEALTH NET PROVIDER ID
AZ56228579101OtherPACIFICARE PROVIDER ID
AZ562285791OtherTAX ID
AZ1550956OtherHEALTH CHOICE PROVIDER ID
AZ550956OtherAHCCCS PROVIDER ID
AZAZ0720420OtherBCBS PROVIDER ID
AZ56228579101OtherPACIFICARE PROVIDER ID
AZAZ0720420OtherBCBS PROVIDER ID