Individual
BRUCE JUNIOUS MABINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST, 7TH FLOOR OUT PATIENT BUILDING, PHILADELPHIA, PA 19140-5103
(215) 707-3008
(215) 707-1387
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-3008
(215) 707-1387
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD023436E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000975172
—
PA
01
—
0052784000
INDEPENDENCE BLUE CROSS
PA
01
—
0097517210
AMERICHOICE
PA
01
—
059989
HIGHMARK BLUE SHIELD
PA
01
—
1036665
KEYSTONE MERCY HEALTH
PA
01
—
3211325
AETNA HMO
PA
01
—
4216207
AETNA PPO
PA
01
—
4590
BRAVO HEALTH
PA
01
—
519073
HEALTH AMERICA
PA
Enumeration date
12/15/2005
Last updated
03/21/2017
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