Provider Demographics
NPI:1174504567
Name:BRUCE, WILLIAM B (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:BRUCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9370
Mailing Address - Country:US
Mailing Address - Phone:570-523-1163
Mailing Address - Fax:570-524-5737
Practice Address - Street 1:80 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9370
Practice Address - Country:US
Practice Address - Phone:570-523-1163
Practice Address - Fax:570-524-5737
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023535E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006288730004Medicaid
PA01650001OtherCAPITAL BLUE CROSS
PA151961OtherHIGHMARK BLUE SHIELD
PA01650001OtherCAPITAL BLUE CROSS
PA0006288730004Medicaid