Individual
DR. BRUCE MARTIN ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
675 N CAUSEWAY BLVD, MANDEVILLE, LA 70448-4600
(985) 200-3530
(985) 202-2010
Mailing address
675 N CAUSEWAY BLVD, MANDEVILLE, LA 70448-4600
(985) 200-3530
(985) 202-2010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
201758
LA
207RC0000X
Cardiovascular Disease Physician
201758
LA
207RI0011X
Interventional Cardiology Physician
Primary
201758
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1973025
—
LA
05
—
2432401
—
LA
01
—
31725ZYJT
MEDICARE
LA
Enumeration date
04/19/2006
Last updated
04/12/2023
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