Provider Demographics
NPI:1427013200
Name:RAJALA, BRUCE WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:WILLIAM
Last Name:RAJALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8154
Mailing Address - Country:US
Mailing Address - Phone:972-747-4848
Mailing Address - Fax:972-747-4949
Practice Address - Street 1:5236 W UNIVERSITY DR
Practice Address - Street 2:SUITE 3700
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7889
Practice Address - Country:US
Practice Address - Phone:214-491-6070
Practice Address - Fax:214-491-6084
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5352207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121154203Medicaid
E20220Medicare UPIN
89X420Medicare ID - Type Unspecified