Provider Demographics
NPI:1780634261
Name:ZURAW, BRUCE L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:L
Last Name:ZURAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9500 GILMAN DR
Mailing Address - Street 2:MAILCODE #0732
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-5004
Mailing Address - Country:US
Mailing Address - Phone:858-822-6597
Mailing Address - Fax:858-642-3791
Practice Address - Street 1:200 WEST ARBOR DRIVE
Practice Address - Street 2:UCSD MEDICAL CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8201
Practice Address - Country:US
Practice Address - Phone:858-657-8322
Practice Address - Fax:619-543-3183
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG47065207K00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G470650Medicaid
A50585Medicare UPIN
CAWG47065IMedicare ID - Type Unspecified