Individual
BRUCE B CHISHOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
39300 BOB HOPE DR, BANNAN BLDG SUITE 1208, RANCHO MIRAGE, CA 92270-3203
(760) 779-9559
(760) 779-5077
Mailing address
39300 BOB HOPE DR, BANNAN BLDG SUITE 1208, RANCHO MIRAGE, CA 92270-3203
(760) 779-9559
(760) 779-5077
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
G81937
CA
2086S0122X
Plastic and Reconstructive Surgery Physician
G81937
CA
261QA1903X
Ambulatory Surgical Clinic/Center
10005
CA
Other
Enumeration date
09/20/2006
Last updated
10/06/2011
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