Individual
MARK D BRUCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2901 N 4TH ST, LONGVIEW, TX 75605-5128
(903) 232-3606
(903) 593-4290
Mailing address
14994 E LAKE CIR, ARP, TX 75750-9781
(903) 859-3403
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
529621
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86187U
BCBS OF TEXAS
TX
01
—
P00273951
PART B RAILROAD MEDICARE
TX
Enumeration date
10/20/2006
Last updated
07/08/2007
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