Individual
MR. MICHAEL T. BRUCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1114 W MADISON AVE, ATHENS, TN 37303-4150
(423) 745-1411
(865) 539-8008
Mailing address
PO BOX 634760, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1265
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4108068
BCBS OF TENNESSEE
TN
01
—
P00285551
RAILROAD MEDICARE
TN
Enumeration date
06/08/2006
Last updated
11/19/2007
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