Provider Demographics
NPI:1184686859
Name:SPEICHER, BRUCE (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:SPEICHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 13TH AVE E
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-5315
Mailing Address - Country:US
Mailing Address - Phone:406-883-5680
Mailing Address - Fax:406-883-8910
Practice Address - Street 1:6 13TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860
Practice Address - Country:US
Practice Address - Phone:406-883-5680
Practice Address - Fax:406-883-8910
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000995207PE0004X
MT68487207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100318640AMedicaid
IN000000181694OtherANTHEM
MI114340109Medicaid
IN930101007OtherRAIL ROAD MEDICARE
IN176490IMedicare PIN
IN100318640AMedicaid