Individual
BRUCE CHARLES BROUDY
Active
Individual
BRUCE CHARLES BROUDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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