Provider Demographics
NPI:1407851678
Name:HILLARD, BRUCE L (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:L
Last Name:HILLARD
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 1:2200 JEFFERSON AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:419-251-1963
Mailing Address - Fax:419-486-8857
Practice Address - Street 1:4041 W SYLVANIA AVE
Practice Address - Street 2:STE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4464
Practice Address - Country:US
Practice Address - Phone:419-472-1124
Practice Address - Fax:419-486-8857
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-02-20
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
OH35061760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0826119Medicaid
OH080166337OtherRAILROAD MEDICARE
OH35061760OtherOH MEDICAL LICENSE
OH35061760OtherOH MEDICAL LICENSE
OH080166337OtherRAILROAD MEDICARE
OH0826119Medicaid