Provider Demographics
NPI:1891768370
Name:O'BRIEN-BRUCE, MOIRA E (DO)
Entity Type:Individual
Prefix:
First Name:MOIRA
Middle Name:E
Last Name:O'BRIEN-BRUCE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:N17 W24100 RIVERWOOD DRIVE
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:2085 N. CALHOUN ROAD
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES, INC.
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-928-7100
Practice Address - Fax:262-513-7111
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-11-09
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Provider Licenses
StateLicense IDTaxonomies
WI25132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30019200Medicaid
WIB85124Medicare UPIN
WI30019200Medicaid
WI002868300Medicare PIN