Provider Demographics
NPI:1275615684
Name:DOW, BRUCE M (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:DOW
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 1:1019 IYANNOUGH RD STE 9
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1839
Mailing Address - Country:US
Mailing Address - Phone:508-862-8061
Mailing Address - Fax:508-862-8064
Practice Address - Street 1:1019 IYANNOUGH RD STE 9
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1839
Practice Address - Country:US
Practice Address - Phone:508-862-8061
Practice Address - Fax:508-862-8064
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG683752084P0800X
MA2384832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1275615684Medicaid