Provider Demographics
NPI:1295059160
Name:LEMON, BRUCE
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:LEMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30195 COUNTY HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-7414
Mailing Address - Country:US
Mailing Address - Phone:218-847-0055
Mailing Address - Fax:
Practice Address - Street 1:30195 COUNTY HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-7414
Practice Address - Country:US
Practice Address - Phone:218-847-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor