Individual
DR. BRUCE E MATHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
417 N 11TH ST, RICHMOND, VA 23298-5002
(804) 828-9165
(804) 828-0374
Mailing address
BOX 91734, RICHMOND, VA 23219-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
0101052126
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
490032CG09729
CMS SECTION 1011 MCV PHYS
VA
05
—
6103456 - 541581185
—
VA
Enumeration date
06/21/2006
Last updated
07/09/2007
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