Provider Demographics
NPI:1619197100
Name:MAYHEW, BRUCE
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:MAYHEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 N KINGS HIGHWAY ST STE E
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-3547
Mailing Address - Country:US
Mailing Address - Phone:573-335-3714
Mailing Address - Fax:573-335-3749
Practice Address - Street 1:1131 N KINGSHIGHWAY ST
Practice Address - Street 2:SUITE E
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-3504
Practice Address - Country:US
Practice Address - Phone:573-335-3714
Practice Address - Fax:573-335-3749
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1734237700000X
MO2006035587237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist