Provider Demographics
NPI:1306166152
Name:GEDDES-BRUCE, ELIZABETH REBECCA (MD)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:REBECCA
Last Name:GEDDES-BRUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:REBECCA
Other - Last Name:GEDDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3637 FAR WEST BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4126
Mailing Address - Country:US
Mailing Address - Phone:512-615-2737
Mailing Address - Fax:512-379-7204
Practice Address - Street 1:3637 FAR WEST BLVD STE E
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4126
Practice Address - Country:US
Practice Address - Phone:512-615-2737
Practice Address - Fax:512-379-7204
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0259207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX381924YS4ZMedicare PIN
TX381924YTAQMedicare PIN