Provider Demographics
NPI:1699820209
Name:FOGAS, BRUCE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:FOGAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89306
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57109
Mailing Address - Country:US
Mailing Address - Phone:605-334-1414
Mailing Address - Fax:605-335-3121
Practice Address - Street 1:1401 W 51ST STREET
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-334-1414
Practice Address - Fax:605-335-3121
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist