Provider Demographics
NPI:1396962536
Name:GAINSLEY, BRUCE MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MARTIN
Last Name:GAINSLEY
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 1:15300 VENTURA BLVD
Mailing Address - Street 2:STE 525
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-906-8515
Mailing Address - Fax:818-344-6411
Practice Address - Street 1:15300 VENTURA BLVD
Practice Address - Street 2:STE 525
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-906-8515
Practice Address - Fax:818-344-6411
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG320322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A91390Medicare UPIN
CAG32032Medicare ID - Type Unspecified