Provider Demographics
NPI:1215423058
Name:DOVE, BRUCE DUANE SR
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:DUANE
Last Name:DOVE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 JEFFERSON AVE STE 133
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208-1827
Mailing Address - Country:US
Mailing Address - Phone:716-948-0435
Mailing Address - Fax:
Practice Address - Street 1:41 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-2629
Practice Address - Country:US
Practice Address - Phone:716-948-0435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver