GORDON BRUCE MD NPI 1295711901

NPI Information

NPI: 1295711901
Provider Name: GORDON BRUCE, MD
Classification: Pediatrics - 2080P0204X
Entity Type: Individual

Specialization: Pediatric Emergency Medicine

PECOS Registration: Yes

Address:
3320 LIVE OAK ST
COPC ADMINISTRATION
DALLAS, TX
ZIP 75204
Phone: (214) 266-1000
Get Directions

Gordon Bruce, MD is a pediatric emergency medicine pediatrics in Dallas, TX. The provider is a pediatrician who has special qualifications to manage emergencies in infants and children. Gordon Bruce, MD NPI is 1295711901. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3320 LIVE OAK ST
COPC ADMINISTRATION
DALLAS, TX
ZIP 75204-109
Phone: (214) 266-1000

The NPI 1295711901 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/15/2005 and was last updated on 12/15/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		J4011	TEXAS	No
2	2080P0204X	Pediatrics	Pediatric Emergency Medicine	J4011	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	113281313	MEDICAID	TEXAS
2	113281305	MEDICAID	TEXAS
3	113281311	MEDICAID	TEXAS
4	113281309	MEDICAID	TEXAS
5	113281312	MEDICAID	TEXAS
6	113281310	MEDICAID	TEXAS
7	113281306	MEDICAID	TEXAS
8	113281304	MEDICAID	TEXAS
9	113281307	MEDICAID	TEXAS
10	113281308	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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