Provider Demographics
NPI:1164847273
Name:ROBERT BRUCE, INC
Entity Type:Organization
Organization Name:ROBERT BRUCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:408-448-3693
Mailing Address - Street 1:PO BOX 18670
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95158-8670
Mailing Address - Country:US
Mailing Address - Phone:408-448-3693
Mailing Address - Fax:408-448-3693
Practice Address - Street 1:4950 CHERRY AVE
Practice Address - Street 2:#41
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-2751
Practice Address - Country:US
Practice Address - Phone:408-448-3693
Practice Address - Fax:408-448-3693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20241363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA20241OtherMEDICAL LICENSE