Provider Demographics
NPI:1295755544
Name:BALDECCHI, BRUCE M (MD)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:M
Last Name:BALDECCHI
Suffix:
Gender:M
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 3797
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-3797
Mailing Address - Country:US
Mailing Address - Phone:775-883-2202
Mailing Address - Fax:775-883-0797
Practice Address - Street 1:313 WEST ANN STREET
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:775-883-2202
Practice Address - Fax:775-883-0797
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3245207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2013025Medicaid
C95748Medicare UPIN