Provider Demographics
NPI:1295841195
Name:MACFADYEN, BRUCE VISCHER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:VISCHER
Last Name:MACFADYEN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3122 MONTPELIER DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3226
Mailing Address - Country:US
Mailing Address - Phone:706-729-1700
Mailing Address - Fax:706-721-2063
Practice Address - Street 1:DEPARTMENT OF SURGERY, BI 4076
Practice Address - Street 2:MEDICAL COLL OF GEORGIA, 1102 15TH STREET
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912
Practice Address - Country:US
Practice Address - Phone:706-721-4651
Practice Address - Fax:706-721-2063
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA051251208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00942983AMedicaid
GAD66862Medicare UPIN
GA00942983AMedicaid