Provider Demographics
NPI:1316256241
Name:BRUCE, MATTHEW DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:BRUCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11775 TECUMSEH CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MI
Mailing Address - Zip Code:49236-9541
Mailing Address - Country:US
Mailing Address - Phone:517-456-7449
Mailing Address - Fax:517-456-6059
Practice Address - Street 1:11775 TECUMSEH CLINTON RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MI
Practice Address - Zip Code:49236-9541
Practice Address - Country:US
Practice Address - Phone:517-456-7449
Practice Address - Fax:517-456-6059
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013531207Q00000X
OH58.004719207Q00000X
MI510109601208600000X
MI5101019601207Q00000X
OH34011486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery