Provider Demographics
NPI:1518291855
Name:BRUCE K HIRA MD
Entity Type:Organization
Organization Name:BRUCE K HIRA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:KIRPAL
Authorized Official - Last Name:HIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1585-266-8220
Mailing Address - Street 1:333 METRO PARK
Mailing Address - Street 2:F203
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2638
Mailing Address - Country:US
Mailing Address - Phone:585-697-3433
Mailing Address - Fax:585-697-7558
Practice Address - Street 1:1726 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2157
Practice Address - Country:US
Practice Address - Phone:585-266-8220
Practice Address - Fax:585-266-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty