Individual
WALLACE B BRUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
321 BUTTS AVE, TOMAH, WI 54660-1412
(608) 374-0303
Mailing address
321 BUTTS AVE, TOMAH, WI 54660-1412
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
48603
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34706400
—
WI
Enumeration date
10/05/2006
Last updated
06/21/2012
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