Provider Demographics
NPI:1609841949
Name:ANDREA, BRUCE E (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:ANDREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 MAIN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5260
Mailing Address - Country:US
Mailing Address - Phone:970-403-0555
Mailing Address - Fax:970-403-0557
Practice Address - Street 1:1201 MAIN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5260
Practice Address - Country:US
Practice Address - Phone:970-403-0555
Practice Address - Fax:970-403-0557
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO33644207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01336445Medicaid
CO01336445Medicaid
COC806786Medicare ID - Type Unspecified