Provider Demographics
NPI:1407629421
Name:BRUCE, SCOT WILLIAM
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:WILLIAM
Last Name:BRUCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 ABBY COURT RD
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48428-0529
Mailing Address - Country:US
Mailing Address - Phone:586-482-2585
Mailing Address - Fax:
Practice Address - Street 1:1350 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6106
Practice Address - Country:US
Practice Address - Phone:248-969-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver