Provider Demographics
NPI:1518078062
Name:BRUCE NEU, M.D., INC., P.S.
Entity Type:Organization
Organization Name:BRUCE NEU, M.D., INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:NEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-821-6000
Mailing Address - Street 1:13114 120TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3014
Mailing Address - Country:US
Mailing Address - Phone:425-821-6000
Mailing Address - Fax:425-820-6288
Practice Address - Street 1:13114 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3014
Practice Address - Country:US
Practice Address - Phone:425-821-6000
Practice Address - Fax:425-820-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00010767208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1629708Medicaid
WA14722OtherWORKER'S COMPENSATION
WAN-370OtherREGENCE BLUE SHIELD
WAN-370OtherREGENCE BLUE SHIELD