Provider Demographics
NPI:1609100080
Name:BRUCE, DOUGLAS BRIAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:BRIAN
Last Name:BRUCE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 E DESOTO ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-3442
Mailing Address - Country:US
Mailing Address - Phone:850-418-1608
Mailing Address - Fax:
Practice Address - Street 1:2100 N 12TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-4717
Practice Address - Country:US
Practice Address - Phone:850-432-6870
Practice Address - Fax:850-432-6815
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52793175F00000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
No175F00000XOther Service ProvidersNaturopath