Provider Demographics
NPI:1851686877
Name:ULRICH, BRUCE ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ANTHONY
Last Name:ULRICH
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 1:32 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-0017
Mailing Address - Country:US
Mailing Address - Phone:828-659-5741
Mailing Address - Fax:828-652-1626
Practice Address - Street 1:32 E MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:NC
Practice Address - Zip Code:28762-0017
Practice Address - Country:US
Practice Address - Phone:828-659-5741
Practice Address - Fax:828-652-1626
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172989390200000X
NC2012-02273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program