Provider Demographics
NPI:1942216585
Name:COREY S BRUCE MD LTD
Entity Type:Organization
Organization Name:COREY S BRUCE MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-351-2229
Mailing Address - Street 1:530 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3204
Mailing Address - Country:US
Mailing Address - Phone:602-351-2229
Mailing Address - Fax:602-351-1500
Practice Address - Street 1:530 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3204
Practice Address - Country:US
Practice Address - Phone:602-351-2229
Practice Address - Fax:602-351-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29104207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ550956Medicaid
AZ550956Medicaid
AZZ72564Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID