Provider Demographics
NPI:1437161973
Name:PHILLIPS, BRUCE A (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:PHILLIPS
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 1:60 MESSENGER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2258
Mailing Address - Country:US
Mailing Address - Phone:508-695-2020
Mailing Address - Fax:509-699-7298
Practice Address - Street 1:60 MESSENGER ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2258
Practice Address - Country:US
Practice Address - Phone:508-695-2020
Practice Address - Fax:509-699-7298
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ12030OtherMABC
0101150OtherUHC
MA3017273Medicaid
400687OtherRI BLUE CHIP
MA43244OtherFALLON
MA710762OtherHPHC
MAB10390501OtherCIGNA
MA000000028142OtherBMC HEALTHNET
MA707079OtherTUFTS
MAJ12030OtherMABC
MAB10390501OtherCIGNA