Provider Demographics
NPI:1942267281
Name:BRUCE, KAREN H (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:H
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-765-4414
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:704 S 5TH ST
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-4147
Practice Address - Country:US
Practice Address - Phone:601-765-4414
Practice Address - Fax:601-765-9141
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00725822Medicaid
MSP01361209OtherRAILROAD MEDICARE
MSP01361209OtherRAILROAD MEDICARE
MSI30543Medicare UPIN
MS00725822Medicaid
MS080004083Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE