Provider Demographics
NPI:1124136718
Name:BRUCE, MARIA FE FIEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA FE
Middle Name:FIEL
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA FE
Other - Middle Name:FIEL
Other - Last Name:DETALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3126 S JACKSON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2534
Mailing Address - Country:US
Mailing Address - Phone:417-781-4727
Mailing Address - Fax:417-627-8727
Practice Address - Street 1:3126 S JACKSON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2534
Practice Address - Country:US
Practice Address - Phone:417-781-4727
Practice Address - Fax:417-627-8727
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109260207Q00000X
MO2007028405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine