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Individual
DR. BRUCE PRESTON THEALL
Active
Individual
DR. BRUCE PRESTON THEALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
25MD00131000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4548860001
MEDICARE NSC
NJ
Enumeration date
10/09/2005
Last updated
01/09/2009
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