Provider Demographics
NPI:1770654055
Name:RAU, BRUCE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WILLIAM
Last Name:RAU
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 1:2990 BETHESDA PL
Mailing Address - Street 2:SUITE 602-A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3318
Mailing Address - Country:US
Mailing Address - Phone:336-768-8281
Mailing Address - Fax:336-768-5685
Practice Address - Street 1:2990 BETHESDA PL
Practice Address - Street 2:SUITE 602-A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3318
Practice Address - Country:US
Practice Address - Phone:336-768-8281
Practice Address - Fax:336-768-5685
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8970534Medicaid
NC8970534Medicaid
NCC86107Medicare UPIN