Provider Demographics
NPI:1760469415
Name:HERR, BRUCE ALLEN JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALLEN
Last Name:HERR
Suffix:JR
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:4200 WISCONSIN AVE NW
Mailing Address - Street 2:STE 106-152
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2143
Mailing Address - Country:US
Mailing Address - Phone:734-735-5761
Mailing Address - Fax:
Practice Address - Street 1:4200 WISCONSIN AVE NW
Practice Address - Street 2:STE 106-152
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2143
Practice Address - Country:US
Practice Address - Phone:202-963-1703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704221887367500000X
MDR235618367500000X
VA0024182902367500000X
DCRN1004845367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD002408200Medicaid
DC05757900Medicaid
MI104682778Medicaid
MIBH221887OtherBLUE CROSS OF MI