Ennis, Bruce Martin
Ennis, Bruce Martin is an sole proprietor health care provider with primary practice located at 675 N Causeway Blvd , Mandeville LA 70448-4600. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Interventional Cardiology. Allopathic & Osteopathic Physicians / Interventional Cardiology is his primary health care specialty. Ennis, Bruce Martin can be contacted via phone (985) 200-3530.Contact Information
Primary practice address
675 N Causeway Blvd
Mandeville LA 70448-4600
Phone: (985) 200-3530
Fax: (985) 202-2010
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 201758 | Louisiana |
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 201758 | Louisiana |
| Allopathic & Osteopathic Physicians / Interventional Cardiology | 207RI0011X | 201758 | Louisiana |
Profile Details
| NPI number | 1639134901 |
|---|---|
| LBN Legal business name | Ennis, Bruce Martin |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 19th, 2006 |
| Last updated | Apr 12th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639134901 | NPPES |
| Louisiana | Other | 31725ZYJT | MEDICARE |
| Louisiana | MEDICAID | 1973025 | MEDICARE |
| Louisiana | MEDICAID | 2432401 | MEDICARE |
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