Provider Demographics
NPI:1629041942
Name:COULL, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:COULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1501 N CAMPBELL AVENUE, 6TH FLOOR
Mailing Address - Street 2:DEPARTMENT OF NEUROLOGY, 6TH FLOOR
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721
Mailing Address - Country:US
Mailing Address - Phone:520-874-3500
Mailing Address - Fax:
Practice Address - Street 1:3838 N CAMPBELL AVE, BLDG 2
Practice Address - Street 2:CLINIC E
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-694-8888
Practice Address - Fax:520-694-0235
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ237872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ130017391OtherRR MEDICARE
AZ130017391OtherRR MEDICARE