Provider Demographics
NPI:1972532240
Name:PIATT, BRUCE E (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:PIATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1720 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-280-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39850207X00000X
ND7695207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND142317OtherUCARE #
MN08Q02PIOtherMNBS #
ND0900329OtherMEDICA #
ND14775OtherNDBS #
ND942323100Medicaid
NDHP22675OtherHEALTHPARTNERS #
NDND200120OtherLHS #
NDDA9011015574OtherPREFERRED ONE #
MN14917OtherNDBS #
MN1972532240Medicaid
ND4448OtherSIOUX VALLEY #
ND07Q16PIOtherMNBS 3
ND0900339OtherMEDICA #
ND683038OtherAMERICA'S PPO/ARAZ #
NDP00868038OtherRR MEDICARE
MN14917OtherNDBS #
MN200001352Medicare ID - Type UnspecifiedMN MEDICARE #
ND10172Medicare ID - Type UnspecifiedND MEDICAID #
ND14775Medicare ID - Type UnspecifiedND MEDICARE #
MN1972532240Medicaid
NDDA9011015574OtherPREFERRED ONE #
MN200028554Medicare ID - Type UnspecifiedRR MEDICARE #