Provider Demographics
NPI:1427175934
Name:BRUCE, ALLEN THOMAS (MD PHD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:THOMAS
Last Name:BRUCE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SEWALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2645
Mailing Address - Country:US
Mailing Address - Phone:207-775-3526
Mailing Address - Fax:207-775-5658
Practice Address - Street 1:50 SEWALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2645
Practice Address - Country:US
Practice Address - Phone:207-775-3526
Practice Address - Fax:207-775-5658
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018852207N00000X
MI4301083648207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315017780OtherCONTROLLED SUBSTANCE LICE