Provider Demographics
NPI:1215185970
Name:BOTTLINGER, BRUCE JAY (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:JAY
Last Name:BOTTLINGER
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 1:501 NORTH COLORADO AVENUE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5251
Mailing Address - Country:US
Mailing Address - Phone:402-705-2374
Mailing Address - Fax:
Practice Address - Street 1:501 NORTH COLORADO AVENUE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-5251
Practice Address - Country:US
Practice Address - Phone:402-705-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE153112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B06906Medicare UPIN