Tucker, Bruce Nicholson

Tucker, Bruce Nicholson is an individual health care provider with primary practice located at 3536 Mendocino Ave Ste 300, Santa Rosa CA 95403-3634. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Tucker, Bruce Nicholson can be contacted via phone (707) 544-3411.

Contact Information

Primary practice address
3536 Mendocino Ave Ste 300 Santa Rosa CA 95403-3634
Phone: (707) 544-3411
Fax: (707) 544-0834
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X G44233 California

Profile Details

NPI number 1780677054
LBN Legal business name Tucker, Bruce Nicholson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 23rd, 2005
Last updated Feb 7th, 2012 - about 12 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 1780677054 NPPES
Other 00G442330 BLUE SHIELD OF CALIFORNIA
MEDICAID 00G442330 BLUE SHIELD OF CALIFORNIA
Other P00420858 BLUE SHIELD OF CALIFORNIA

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