Provider Demographics
NPI:1790993319
Name:SENTER, BRUCE STOCKER (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STOCKER
Last Name:SENTER
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:PO BOX 9328
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39286-9328
Mailing Address - Country:US
Mailing Address - Phone:601-982-7811
Mailing Address - Fax:601-982-3346
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:SUITE 950
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4643
Practice Address - Country:US
Practice Address - Phone:601-982-7811
Practice Address - Fax:601-982-3346
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11420207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B30952Medicare UPIN