Provider Demographics
NPI:1598705345
Name:TROUTMAN, BRUCE W (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:TROUTMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2700 ROBERT T LONGWAY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2190
Mailing Address - Country:US
Mailing Address - Phone:810-235-2004
Mailing Address - Fax:810-235-2841
Practice Address - Street 1:1024 PROFESSIONAL DR STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3635
Practice Address - Country:US
Practice Address - Phone:810-230-9260
Practice Address - Fax:810-230-8798
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101006563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F38765Medicare UPIN