Individual
BRUCE GREENWOOD NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 532-8620
(714) 289-4072
Mailing address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 289-4511
(714) 289-4788
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
G38843
CA
2080P0214X
Pediatric Pulmonology Physician
Primary
G38843
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G388430
—
CA
01
—
WG38843F
MEDICARE PTAN
CA
Enumeration date
10/12/2006
Last updated
08/08/2008
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