Provider Demographics
NPI:1255453924
Name:MARUCCI, BERNARD-DEAN FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD-DEAN
Middle Name:FRANK
Last Name:MARUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1207 PUEBLO BOULEVARD WAY
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2175
Mailing Address - Country:US
Mailing Address - Phone:719-542-0032
Mailing Address - Fax:719-296-6217
Practice Address - Street 1:1207 PUEBLO BOULEVARD WAY
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2175
Practice Address - Country:US
Practice Address - Phone:719-542-0032
Practice Address - Fax:719-296-6217
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14029207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine