Individual
DR. BRUCE G FAWCETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1514 GLENWOOD AVE, RALEIGH, NC 27608-2368
(919) 829-0076
(919) 836-9094
Mailing address
1514 GLENWOOD AVENUE, RALEIGH, NC 27608-2368
(919) 829-0076
(919) 836-9094
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
154
NC
213EP0504X
Public Medicine Podiatrist
154
NC
213EP1101X
Primary Podiatric Medicine Podiatrist
154
NC
213ER0200X
Radiology Podiatrist
154
NC
213ES0000X
Sports Medicine Podiatrist
154
NC
213ES0131X
Foot Surgery Podiatrist
154
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08064
BCBS
NC
01
—
1115086015
CIGNA
NC
01
—
16437
PARTNERS
NC
01
—
2751610
UNITED
NC
01
—
4279205
AETNA
NC
01
—
440912
OPTIMUM CHOICE
NC
01
—
480017899
RAILROAD MEDICARE
NC
01
—
561412156
HUMANA
NC
05
—
7908064
—
NC
Enumeration date
10/11/2006
Last updated
04/04/2016
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