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Individual

BRUCE CHARLES BROUDY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1225 S. BROADWAY, SUITE 201, LEXINGTON, KY 40504-2701
(859) 258-4568
(859) 258-4698
Mailing address
1225 S. BROADWAY, SUITE 201, LEXINGTON, KY 40504-2701
(859) 258-4568
(859) 258-4698

Taxonomy

Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
18112
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
010056744
RR MEDICARE PIN
KY
01
36000818
MEDICAID ASC GROUP
KY
01
37903705
MEDICAID LAB GROUP
KY
01
4000501
MEDICARE LAB GROUP
KY
05
64181126
KY
01
ASC1019
MEDICARE ASC GROUP
KY
01
CB5773
RR MEDICARE GROUP
KY
Enumeration date
07/03/2006
Last updated
10/10/2012
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