Mack, Bruce James

Mack, Bruce James is an individual health care provider with primary practice located at 4225 Golden Valley Rd , Golden Valley MN 55422-4215. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Mack, Bruce James can be contacted via phone (763) 588-0661.

Contact Information

Primary practice address
4225 Golden Valley Rd Golden Valley MN 55422-4215
Phone: (763) 588-0661
Fax: (763) 287-2310
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 40493 Minnesota

Profile Details

NPI number 1013958339
LBN Legal business name Mack, Bruce James
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2006
Last updated Jul 11th, 2007 - about 17 years ago

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 1013958339 NPPES
Minnesota Other 0500046 MEDICA
Minnesota MEDICAID 32438000 MEDICA
Minnesota Other 35Q98MA MEDICA
Minnesota Other 769546 MEDICA
Minnesota Other HP24316 MEDICA
Minnesota Other 1015838 MEDICA

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