Provider Demographics
NPI:1700840238
Name:NIXON, BRUCE R (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:R
Last Name:NIXON
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5015
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-0915
Mailing Address - Country:US
Mailing Address - Phone:925-837-5616
Mailing Address - Fax:
Practice Address - Street 1:2000 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1716
Practice Address - Country:US
Practice Address - Phone:510-797-3342
Practice Address - Fax:510-713-8776
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG456772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology