Provider Demographics
NPI:1780686840
Name:KINZY, BRUCE G (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:G
Last Name:KINZY
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 1:30975 ELISE ANN
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-4139
Mailing Address - Country:US
Mailing Address - Phone:830-980-4660
Mailing Address - Fax:830-438-7646
Practice Address - Street 1:30975 ELISE ANN
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-4139
Practice Address - Country:US
Practice Address - Phone:830-980-4660
Practice Address - Fax:830-438-7646
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8745207Q00000X, 208100000X
MOMD33489207Q00000X, 208100000X
KY30399207Q00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM809OtherBLUE CROSS BLUE SHIELD
TX135375709Medicaid
TXM809OtherBLUE CROSS BLUE SHIELD
TX135375709Medicaid