Individual
BRUCE MICHAEL DISTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3186 VILLAGE DR STE 201, FAYETTEVILLE, NC 28304-3979
(910) 486-5700
(910) 486-5950
Mailing address
3186 VILLAGE DR 201, FAYETTEVILLE, NC 28304-3979
(910) 486-5700
(910) 486-5950
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
33497
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891140T
—
NC
Enumeration date
06/17/2005
Last updated
10/30/2023
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