Provider Demographics
NPI:1295739894
Name:BRUCE, ANDREA MAUREEN (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MAUREEN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:DO
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 2499
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-2499
Mailing Address - Country:US
Mailing Address - Phone:601-765-3180
Mailing Address - Fax:601-765-2808
Practice Address - Street 1:701 S HOLLY AVE
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-3894
Practice Address - Country:US
Practice Address - Phone:601-765-3180
Practice Address - Fax:601-765-2808
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17397207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124844Medicaid
BB3716555OtherDEA
BB3716555OtherDEA
080003623Medicare ID - Type Unspecified