Provider Demographics
NPI:1699859454
Name:BRUCE, JAMES MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:BRUCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1105 E SPRUCE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3313
Mailing Address - Country:US
Mailing Address - Phone:559-450-7200
Mailing Address - Fax:559-450-7214
Practice Address - Street 1:1105 E SPRUCE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3313
Practice Address - Country:US
Practice Address - Phone:559-450-7200
Practice Address - Fax:559-450-7214
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC42011208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C420110Medicare PIN
A37727Medicare UPIN