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Organization

BRUCE C MCCOMAS, M. D., P. A.

Active
Other names
Southern Idaho Vein Care Center
Organization subpart
No

Provider details

NPI number
Authorized official
BRUCE C MCCOMAS M.D. (PHYSICIAN)
(208) 734-3596
Entity
Organization

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
RR MEDICARE
ID
Enumeration date
06/04/2006
Last updated
03/09/2013
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