Organization
BRUCE D DRAGOO MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FREDA LYN LARKIN (BILLING)
(616) 957-3643
Entity
Organization
Contact information
Practice address
1000 E PARIS AVE SE, SUITE 225, GRAND RAPIDS, MI 49546-3691
(616) 957-3643
(616) 957-0896
Mailing address
1000 E PARIS AVE SE, SUITE 225, GRAND RAPIDS, MI 49546-3691
(616) 957-3643
(616) 957-0896
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
4301028716
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083311
—
MI
01
—
4301028716
STATE LICENSE NUMBER
MI
01
—
BD028716
BC MI ID NUMBER
MI
Enumeration date
03/14/2007
Last updated
04/20/2008
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