Provider Demographics
NPI:1669416871
Name:BRUCE, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BRUCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:861 SW 78TH AVE
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3229
Mailing Address - Country:US
Mailing Address - Phone:954-693-0000
Mailing Address - Fax:954-693-0005
Practice Address - Street 1:1551 HIGHWAY 34 S
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-4833
Practice Address - Country:US
Practice Address - Phone:972-551-6860
Practice Address - Fax:972-551-6811
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH8591207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE39889Medicare UPIN