Provider Demographics
NPI:1790767796
Name:LEFORCE, BRUCE R (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:R
Last Name:LEFORCE
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 1:25723 OLD FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-6605
Mailing Address - Country:US
Mailing Address - Phone:210-450-6800
Mailing Address - Fax:
Practice Address - Street 1:25723 OLD FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78015-6605
Practice Address - Country:US
Practice Address - Phone:210-450-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD302932084N0400X
TXJ35332084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN130018418OtherRRM
TN130018418OtherRRM
TNF48819Medicare UPIN