Provider Demographics
NPI:1659415800
Name:MCLUCAS, BRUCE BEEZLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:BEEZLEY
Last Name:MCLUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9663 SANTA MONICA BLVD # 1126
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-208-2442
Mailing Address - Fax:310-208-2621
Practice Address - Street 1:9201 W SUNSET BLVD STE 401
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3705
Practice Address - Country:US
Practice Address - Phone:310-208-2442
Practice Address - Fax:310-208-2621
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A45048Medicare UPIN