Individual
BRUCE C MCCOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
775 POLE LINE RD W, SUITE 212, TWIN FALLS, ID 83301-5814
(208) 814-8400
(208) 734-3045
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M5070
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000369200
—
ID
01
—
020048945
MCRR - SIGS
ID
01
—
P00721163
MCRR - SLC
ID
Enumeration date
06/29/2006
Last updated
12/29/2014
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