Provider Demographics
NPI:1285357970
Name:BRUCE, DORIAN ANDRE SR
Entity type:Individual
Prefix:
First Name:DORIAN
Middle Name:ANDRE
Last Name:BRUCE
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 1:29131 RIVERGATE RUN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6547
Mailing Address - Country:US
Mailing Address - Phone:334-406-3605
Mailing Address - Fax:
Practice Address - Street 1:29131 RIVERGATE RUN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-6547
Practice Address - Country:US
Practice Address - Phone:334-406-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care