Individual
DR. BRUCE JAMES MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
40493
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500046
MEDICA
MN
01
—
1015838
PREFERRED ONE
MN
05
—
32438000
—
WI
01
—
35Q98MA
BCBS OF MN
MN
01
—
769546
AMERICA'S PPO
MN
01
—
HP24316
HEALTHPARTNERS
MN
Enumeration date
06/09/2006
Last updated
07/11/2007
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