Provider Demographics
NPI:1336339225
Name:WEATHERS, BRUCE KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:KENT
Last Name:WEATHERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:B
Other - Middle Name:KENT
Other - Last Name:WEATHERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER ATTN: MCHJ-EDME
Mailing Address - Street 2:9040 REID STREET
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-0354
Mailing Address - Fax:253-968-5926
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER ATTN: MCHJ-EDME
Practice Address - Street 2:9040 REID STREET
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-0354
Practice Address - Fax:253-968-5926
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD52840208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice