Distell, Bruce Michael

Distell, Bruce Michael is an individual health care provider with primary practice located at 3186 Village Dr Ste 201 , Fayetteville NC 28304-3979. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Distell, Bruce Michael can be contacted via phone (910) 486-5700.

Contact Information

Primary practice address
3186 Village Dr Ste 201 Fayetteville NC 28304-3979
Phone: (910) 486-5700
Fax: (910) 486-5950
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 33497 North Carolina

Profile Details

NPI number 1245235001
LBN Legal business name Distell, Bruce Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2005
Last updated Oct 30th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245235001 NPPES
North Carolina MEDICAID 891140T

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