Provider Demographics
NPI:1811165467
Name:BRUCE, BRANDON THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:THOMAS
Last Name:BRUCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:200 S ENOTA DR NE
Practice Address - Street 2:SUITE 150
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3473
Practice Address - Country:US
Practice Address - Phone:770-219-3202
Practice Address - Fax:770-219-3209
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071050207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100077900Medicaid
00258358Medicare PIN