Provider Demographics
NPI:1811093461
Name:KESSLER, BRUCE EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:EDWARD
Last Name:KESSLER
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 1:2280 HARRISON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3200
Mailing Address - Country:US
Mailing Address - Phone:707-443-9371
Mailing Address - Fax:
Practice Address - Street 1:2280 HARRISON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3200
Practice Address - Country:US
Practice Address - Phone:707-443-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G17750Medicaid
CA00G317750Medicare PIN
CA00G17750Medicaid