Provider Demographics
NPI:1891781266
Name:REIMERS, BRUCE L (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:L
Last Name:REIMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3220 N ACADEMY BLVD
Mailing Address - Street 2:#4
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5189
Mailing Address - Country:US
Mailing Address - Phone:719-635-2503
Mailing Address - Fax:719-635-4673
Practice Address - Street 1:3220 N ACADEMY BLVD
Practice Address - Street 2:#4
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5189
Practice Address - Country:US
Practice Address - Phone:719-635-2503
Practice Address - Fax:719-635-4673
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO19475208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01194752Medicaid
CO01194752Medicaid
CO5397390001Medicare NSC
E04800Medicare UPIN