Provider Demographics
NPI:1558366047
Name:DREYFUSS, BRUCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:DREYFUSS
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 1:25 N 14TH ST
Mailing Address - Street 2:STE 890
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6216
Mailing Address - Country:US
Mailing Address - Phone:408-288-6623
Mailing Address - Fax:408-288-6698
Practice Address - Street 1:25 N 14TH ST
Practice Address - Street 2:STE 890
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6216
Practice Address - Country:US
Practice Address - Phone:408-288-6623
Practice Address - Fax:408-288-6698
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64297207RR0500X
CARHC1422682471B0102X
CAFAC52131261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone Densitometry
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA660003967OtherRAILROAD MEDICARE
CAZZZ54863ZOtherBLUE SHIELD #
CA110048492OtherRAILROAD MEDICARE
CA5148629Medicaid
CA110048492OtherRAILROAD MEDICARE
CAD49813Medicare UPIN
CA5148629Medicaid