Provider Demographics
NPI:1063433597
Name:MCCANN, BRUCE G (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:G
Last Name:MCCANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3839
Mailing Address - Country:US
Mailing Address - Phone:909-881-7320
Mailing Address - Fax:909-881-7330
Practice Address - Street 1:742 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNRDINO
Practice Address - State:CA
Practice Address - Zip Code:92405
Practice Address - Country:UM
Practice Address - Phone:909-881-7320
Practice Address - Fax:909-881-7330
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10744363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM0962375OtherDEA