Provider Demographics
NPI:1245234624
Name:STECHMILLER, BRUCE K (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:K
Last Name:STECHMILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7015 A C SKINNER PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-2113
Mailing Address - Fax:043-632-6069
Practice Address - Street 1:121 WHITEHALL DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5266
Practice Address - Country:US
Practice Address - Phone:904-825-4500
Practice Address - Fax:904-825-3672
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME31926207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037603500Medicaid
FL68120YMedicare PIN
FL037603500Medicaid
FLD82524Medicare UPIN