Provider Demographics
NPI:1366670200
Name:BRUCE S BARBOUR, MD
Entity Type:Organization
Organization Name:BRUCE S BARBOUR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-787-1995
Mailing Address - Street 1:900 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2457
Mailing Address - Country:US
Mailing Address - Phone:517-787-1995
Mailing Address - Fax:517-789-8657
Practice Address - Street 1:900 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2457
Practice Address - Country:US
Practice Address - Phone:517-787-1995
Practice Address - Fax:517-789-8657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty