Provider Demographics
NPI:1588661979
Name:BRUCE, SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
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 1:1900 SAINT JAMES PL
Mailing Address - Street 2:SUITE 600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-4129
Mailing Address - Country:US
Mailing Address - Phone:713-850-0240
Mailing Address - Fax:713-850-0895
Practice Address - Street 1:1900 SAINT JAMES PL
Practice Address - Street 2:SUITE 600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-4129
Practice Address - Country:US
Practice Address - Phone:713-850-0240
Practice Address - Fax:713-850-0895
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9248207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13884Medicare UPIN
TX85710KMedicare ID - Type Unspecified