Organization
DAVID R BRUCE DO INC
Active
Other names
JACKSON DERMATOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID RANDALL BRUCE D.O. (PRESIDENT)
(209) 223-0038
Entity
Organization
Contact information
Practice address
817 COURT ST, SUITE #11, JACKSON, CA 95642-2156
(209) 223-0038
(209) 223-0039
Mailing address
817 COURT ST, SUITE # 11, JACKSON, CA 95642-2156
(209) 223-0038
(209) 223-0039
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
20A5045
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164466041
NPI
CA
Enumeration date
08/28/2008
Last updated
03/02/2009
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