Provider Demographics
NPI:1548233893
Name:MACDONALD, BRUCE G (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:G
Last Name:MACDONALD
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 1:1329 KAMUS WAY FI
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-9639
Mailing Address - Country:US
Mailing Address - Phone:253-549-2302
Mailing Address - Fax:
Practice Address - Street 1:1329 KAMUS WAY FI
Practice Address - Street 2:
Practice Address - City:FOX ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98333-9639
Practice Address - Country:US
Practice Address - Phone:253-549-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine