Provider Demographics
NPI:1740389659
Name:FOREMAN, BRUCE PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:PHILLIP
Last Name:FOREMAN
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 1:122 W CASTELLANO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6170
Mailing Address - Country:US
Mailing Address - Phone:915-577-0100
Mailing Address - Fax:915-225-0134
Practice Address - Street 1:122 W CASTELLANO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6170
Practice Address - Country:US
Practice Address - Phone:915-577-0100
Practice Address - Fax:915-225-0134
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG07072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC33178Medicare UPIN
TX8A9457Medicare ID - Type Unspecified