Individual
MR. BRUCE A. JENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
430 W MAIN ST STE 1, DOTHAN, AL 36301-1616
(334) 794-0507
Mailing address
604 OVERLOOK DR, DOTHAN, AL 36303-1337
(334) 702-1577
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PTH2193
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTH2193
PHYSICAL LICENSE
AL
Enumeration date
12/05/2006
Last updated
07/08/2007
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