Provider Demographics
NPI:1639136385
Name:BRUCE, JULIA LYNN
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:LYNN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:LYNN
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:900 14TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631
Mailing Address - Country:US
Mailing Address - Phone:970-304-0010
Mailing Address - Fax:970-304-0903
Practice Address - Street 1:900 14TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631
Practice Address - Country:US
Practice Address - Phone:970-304-0010
Practice Address - Fax:970-304-0903
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31120207R00000X, 207RN0300X
NE26748207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95534334Medicaid
COCO40972Medicare PIN
COCO300391Medicare PIN
CO95534334Medicaid
CO471088Medicare PIN