Provider Demographics
NPI:1558465799
Name:LE, BRUCE N (DO, MS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:N
Last Name:LE
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2632
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93279-2632
Mailing Address - Country:US
Mailing Address - Phone:559-625-0551
Mailing Address - Fax:559-733-4475
Practice Address - Street 1:820 SOUTH AKERS
Practice Address - Street 2:220
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8309
Practice Address - Country:US
Practice Address - Phone:559-625-0551
Practice Address - Fax:559-733-4475
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7965207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A79650Medicare ID - Type Unspecified
CAH47240Medicare UPIN