Provider Demographics
NPI:1710401005
Name:BRUCE, JONATHAN (RT(R)(ARRT))
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BRUCE
Suffix:
Gender:M
Credentials:RT(R)(ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 E CACHE LA POUDRE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4613
Mailing Address - Country:US
Mailing Address - Phone:719-822-1532
Mailing Address - Fax:
Practice Address - Street 1:1703 E CACHE LA POUDRE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4613
Practice Address - Country:US
Practice Address - Phone:719-822-1532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1697662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty