Provider Demographics
NPI:1942449095
Name:WRAA, BRUCE ARTHUR (MT, ASCP)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ARTHUR
Last Name:WRAA
Suffix:
Gender:M
Credentials:MT, ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 S CATHAY WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4859
Mailing Address - Country:US
Mailing Address - Phone:303-693-2126
Mailing Address - Fax:
Practice Address - Street 1:5255 S CATHAY WAY
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-4859
Practice Address - Country:US
Practice Address - Phone:303-693-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTA22223291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT-98209OtherAMER. SOC. OF CLIN PATH. CERTIFIED MEDICAL TECHNOLOGIST
CAMTA 22223OtherCALIFORNIA LICENSED MEDICAL TECHNOLOGIST