Provider Demographics
NPI:1316053846
Name:SAYLOR, BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:SAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:
Other - Last Name:SAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1612 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2750
Mailing Address - Country:US
Mailing Address - Phone:228-864-8454
Mailing Address - Fax:228-865-1457
Practice Address - Street 1:5120 BEATLINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-3815
Practice Address - Country:US
Practice Address - Phone:228-868-4294
Practice Address - Fax:228-868-4293
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124144Medicaid
MS$$$$$$$$$COtherBCBS
MS00124144Medicaid
MSC95454Medicare UPIN
MS930003501Medicare PIN
MS00124144Medicaid