Provider Demographics
NPI:1376560839
Name:HALL, BRUCE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LEE
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8109-37-920
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-7224
Mailing Address - Fax:877-991-4780
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV SURG ONCOLOGY, STE 5B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-0060
Practice Address - Fax:314-747-4871
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-11-17
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Provider Licenses
StateLicense IDTaxonomies
MO20001611232086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205109804Medicaid
MO205109804Medicaid
IL$$$$$$$$$Medicaid
MO101010181Medicare PIN