Provider Demographics
NPI:1932136785
Name:ACKERMAN, BRUCE LANCE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LANCE
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 PALM VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1340
Mailing Address - Country:US
Mailing Address - Phone:972-840-0733
Mailing Address - Fax:
Practice Address - Street 1:6446 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5943
Practice Address - Country:US
Practice Address - Phone:972-226-0575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1842207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099850201Medicaid
TX00SE84Medicare PIN
TX099850201Medicaid