Provider Demographics
NPI:1811956907
Name:GILLERS, BRUCE JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JOEL
Last Name:GILLERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:67 UNION ST
Mailing Address - Street 2:SUITE 408
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:508-651-3601
Mailing Address - Fax:508-650-0569
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:SUITE 408
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-651-3601
Practice Address - Fax:508-650-0569
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA52446207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2000000287OtherHARVARD PILGRIM HEALTHCARE
MA052446OtherTUFTS HEALTH PLAN
MAJ03547OtherBLUE SHIELD OF MASSACHUSETTS
MAV08997042OtherCIGNA HEALTHCARE
MA6185886Medicaid
MA4256OtherFALLON COMMUNITY HEALTH PLAN
MA0800001OtherUNITED HEALTHCARE
MA180002661OtherMEDICARE RAILROAD
MA052446OtherTUFTS HEALTH PLAN
MA0800001OtherUNITED HEALTHCARE