Provider Demographics
NPI:1891749495
Name:SUCKLING, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:SUCKLING
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 1:1725 E BOULDER STREET, SUITE 204
Mailing Address - Street 2:PULMONARY ASSOCIATES
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5756
Mailing Address - Country:US
Mailing Address - Phone:719-471-1069
Mailing Address - Fax:719-577-4828
Practice Address - Street 1:1725 E BOULDER STREET, SUITE 204
Practice Address - Street 2:PULMONARY ASSOCIATES
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5756
Practice Address - Country:US
Practice Address - Phone:719-417-1909
Practice Address - Fax:719-447-0425
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057328207RP1001X
CO46262207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15539342Medicaid
C300345Medicare PIN
COCO300617Medicare PIN
CO15539342Medicaid