Provider Demographics
NPI:1669465191
Name:MCFALL, BRUCE HENRY (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HENRY
Last Name:MCFALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WATERWHEEL CIR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6262
Mailing Address - Country:US
Mailing Address - Phone:302-698-0299
Mailing Address - Fax:302-677-2526
Practice Address - Street 1:1010 N BANCROFT PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2690
Practice Address - Country:US
Practice Address - Phone:302-652-2455
Practice Address - Fax:302-652-2444
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27602083A0100X
DEC2-0008353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace MedicineGroup - Multi-Specialty