Individual
DR. BRUCE ALLAN GUEBARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5104 N CLINTON ST, FORT WAYNE, IN 46825-5720
(260) 422-2481
(260) 969-3067
Mailing address
1234 E DUPONT RD, SUITE1, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027774A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000595574
ANTHEM
IN
05
—
100054660
—
IN
01
—
P00698414
RAILROAD MEDICARE
IN
Enumeration date
08/20/2006
Last updated
03/26/2013
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