Provider Demographics
NPI:1558322438
Name:BRUCE, LENA R (MD)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:R
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12422 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-7608
Mailing Address - Country:US
Mailing Address - Phone:409-316-9298
Mailing Address - Fax:409-316-9336
Practice Address - Street 1:12422 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77510-7608
Practice Address - Country:US
Practice Address - Phone:409-316-9298
Practice Address - Fax:409-316-9336
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6081173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00801QOtherPTAN
TX00801QOtherPTAN