Provider Demographics
NPI:1356323448
Name:BRUCE, ROBERT GRADY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GRADY
Last Name:BRUCE
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 1:8240 N MOPAC EXPY STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8869
Mailing Address - Country:US
Mailing Address - Phone:512-687-1950
Mailing Address - Fax:
Practice Address - Street 1:16040 PARK VALLEY DR STE 111
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3596
Practice Address - Country:US
Practice Address - Phone:512-248-2200
Practice Address - Fax:512-248-1950
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6357208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F6341Medicare PIN
TX8786N0Medicare ID - Type Unspecified
TXF89741Medicare UPIN