Individual
DR. BRUCE JAMES MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4225 GOLDEN VALLEY RD, GOLDEN VALLEY, MN 55422-4215
(763) 588-0661
(763) 287-2310
Mailing address
4225 GOLDEN VALLEY RD, GOLDEN VALLEY, MN 55422-4215
(763) 588-0661
(763) 287-2310
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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