Organization
MEDICAL PARK EAR NOSE & THROAT LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM B BRUCE MD (MEDICAL DOCTOR)
(570) 523-1163
Entity
Organization
Contact information
Practice address
80 MEDICAL PARK DR, LEWISBURG, PA 17837-6343
(570) 523-1163
(570) 524-5737
Mailing address
80 MEDICAL PARK DR, LEWISBURG, PA 17837-6343
(570) 523-1163
(570) 524-5737
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD023535E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01650001
CAPITAL BLUE CROSS
PA
01
—
072467
MEDICARE PTAN
PA
05
—
1007486870002
—
PA
Enumeration date
07/19/2005
Last updated
01/14/2013
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