Provider Demographics
NPI:1851494728
Name:HORWITZ, BRUCE ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALEX
Last Name:HORWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-0618
Mailing Address - Country:US
Mailing Address - Phone:510-433-1040
Mailing Address - Fax:510-433-1043
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:SUITE 1202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-433-1040
Practice Address - Fax:510-433-1043
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC25572208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB16516Medicare UPIN