Provider Demographics
NPI:1205820446
Name:EHNI, BRUCE LOYAL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LOYAL
Last Name:EHNI
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 1:2532 BLUE BONNET BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3504
Mailing Address - Country:US
Mailing Address - Phone:713-664-4483
Mailing Address - Fax:713-794-7352
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:580-112 NEUROSURGERY
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-791-1414
Practice Address - Fax:713-794-7352
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6337207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129878804Medicaid
TX84Z192OtherBC/BS OF TEXAS
TX129878804Medicaid
TXB22473Medicare UPIN