Provider Demographics
NPI:1972502219
Name:BRUCE, JINNIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JINNIE
Middle Name:A
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:979-691-3300
Mailing Address - Fax:
Practice Address - Street 1:2600 E PFLUGERVILLE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5999
Practice Address - Country:US
Practice Address - Phone:512-654-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6546208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196245804Medicaid
TX196245808Medicaid
TX8CX666OtherBCBS
TX196245803Medicaid
TX196245807Medicaid
TX8K9726Medicare PIN
TXTXB137023Medicare PIN
TXTXB137017Medicare PIN
TX8K9725Medicare PIN