Provider Demographics
NPI:1497715916
Name:TJADEN, BRUCE LYNN (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:LYNN
Last Name:TJADEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9300 E 29TH ST N
Mailing Address - Street 2:STE 102
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2182
Mailing Address - Country:US
Mailing Address - Phone:316-687-2112
Mailing Address - Fax:316-687-1260
Practice Address - Street 1:9300 E 29TH ST N
Practice Address - Street 2:STE 102
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2182
Practice Address - Country:US
Practice Address - Phone:316-687-2112
Practice Address - Fax:316-687-1260
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS05-24641207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology