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Individual
BRUCE A WING
Active
Individual
BRUCE A WING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60705033
WA
363AM0700X
Medical Physician Assistant
PA 19509
CA
363AS0400X
Surgical Physician Assistant
AMD 412
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433905099
—
ME
Enumeration date
11/12/2007
Last updated
05/21/2018
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