Individual
BRUCE E MAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4301 HOYT AVE, EVERETT, WA 98203-2316
(425) 317-8025
Mailing address
4301 HOYT AVE, EVERETT, WA 98203-2316
(425) 317-8025
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00017709
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0169597
LABOR AND INDUSTRY
WA
05
—
1587708
—
WA
01
—
MD00017709
STATE LICENSE NUMBER
WA
Enumeration date
06/06/2006
Last updated
01/11/2008
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