Individual
BRUCE DOUGLAS DRAGOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 EAST PARIS SE, STE 225, GRAND RAPIDS, MI 49546
(616) 957-3643
(616) 957-0896
Mailing address
1000 EAST PARIS SE, STE 225, GRAND RAPIDS, MI 49546
(616) 957-3643
(616) 957-0896
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301028716
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083311
—
MI
01
—
180D117670
BLUE CROSS & BLUE SHIELD
MI
01
—
382237488
PRIORITY HEALTH
MI
01
—
4301028716
MI STATE LICENSE
MI
01
—
BD028716
MI BCBS STAT LICENSE
MI
Enumeration date
06/17/2005
Last updated
03/11/2021
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