Provider Demographics
NPI:1629042486
Name:PICHLER, BRUCE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:PICHLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:A
Other - Last Name:PICHLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:59 TIPTON DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1603
Mailing Address - Country:US
Mailing Address - Phone:706-864-0169
Mailing Address - Fax:706-864-5396
Practice Address - Street 1:59 TIPTON DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1603
Practice Address - Country:US
Practice Address - Phone:706-864-0169
Practice Address - Fax:706-864-5396
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD-001079213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00686475OtherRAILROAD MEDICARE
GA704639004AMedicaid
GAP00686475OtherRAILROAD MEDICARE
GA704639004AMedicaid