Individual
DR. BRUCE EDMUND STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
891 W LOCUST ST, WILMINGTON, OH 45177-2118
(937) 382-5030
(937) 655-8390
Mailing address
891 W LOCUST ST, WILMINGTON, OH 45177-2118
(937) 382-5030
(937) 655-8390
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35046235S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000020491
ANTHEM
OH
01
—
00000020491
IRON WORKERS BENEFIT TRUS
—
01
—
0014450
TRICARE FOR LIFE
—
01
—
0420218
UNITED HEALTHCARE
—
05
—
0551451
—
OH
01
—
46235
HUMANA CHOICE CARE
—
01
—
IN9287051
MEDICARE GROUP
OH
Enumeration date
08/24/2005
Last updated
05/06/2008
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