Provider Demographics
NPI:1598758997
Name:BRUCE, LORRAINE ANN (MD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:ANN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:A
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-551-2286
Mailing Address - Fax:
Practice Address - Street 1:111 OMNI DRIVE
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-3245
Practice Address - Country:US
Practice Address - Phone:864-882-4222
Practice Address - Fax:864-888-0023
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC136249Medicaid
SC372048Medicaid
SCF030725664Medicare PIN
SC372048Medicaid
SCF03072Medicare UPIN