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Individual

MR. BRUCE F COMMON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
2100 N 12TH AVE, PENSACOLA, FL 32503-4717
(850) 432-6870
(850) 432-6815
Mailing address
1728 N 13TH AVE, PENSACOLA, FL 32503-5346

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA16192
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C5793
BLUE CROSS BLUE SHIELD FL
FL
Enumeration date
08/11/2006
Last updated
07/08/2007
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