Provider Demographics
NPI:1801841556
Name:HIRA, BRUCE K (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:K
Last Name:HIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ASHOK
Other - Middle Name:K
Other - Last Name:HIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 CARTER ST
Mailing Address - Street 2:ATTN KELLY STEELE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-266-8220
Mailing Address - Fax:585-336-4845
Practice Address - Street 1:1726 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2157
Practice Address - Country:US
Practice Address - Phone:585-266-8220
Practice Address - Fax:585-266-4491
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1914671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027293701OtherUNIVERA #
NY080096062OtherMEDICARE RAILROAD #
NY191467-0BOtherWORKERS COMP #
NYP010191467OtherBLUE CHOICE #
NY0192675OtherIHA #
NY4390OtherSIDNEY HILLMAN #
NY101452BFOtherPREFERRED CARE #
NY191467-0BOtherWORKERS COMP #
D64145Medicare UPIN