Provider Demographics
NPI:1689643157
Name:BRUCE, VERNON ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:ROGER
Last Name:BRUCE
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 1:225 RAINBOW DR
Mailing Address - Street 2:12536
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-2025
Mailing Address - Country:US
Mailing Address - Phone:210-663-2197
Mailing Address - Fax:
Practice Address - Street 1:107 E TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5262
Practice Address - Country:US
Practice Address - Phone:210-663-2197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine