Individual
DR. BRUCE JOSEPH SIEDLECKI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
MTN.HOME AIF FORCE BASE, MDOS, MTN. HOME, ID 83647
(208) 828-7567
Mailing address
1050 NW BLUEGRASS CIR, MTN HOME, ID 83647-1544
(208) 828-7567
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD25309
TN
Other
Enumeration date
09/07/2005
Last updated
07/08/2007
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