Richard L Bruck M D a Professional Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

G30560 Issued in CA

Legal business name

RICHARD L BRUCK M D A PROFESSIONAL CORPORATION

Practice address

591 N 13TH Ave
Ste.3
Upland, CA 91786-4967

Phone

(951) 217-8640

Fax

(909) 920-3379

NPI assigned

Oct 10, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Richard Lawrence Bruck I, MD

Title

Owner

Phone

(951) 217-8640

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1194913624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "591 N 13TH AVE",
            "address_2": "STE.3",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864967",
            "telephone_number": "909-985-5885",
            "fax_number": "909-920-3379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 N 13TH AVE",
            "address_2": "STE.3",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864967",
            "telephone_number": "951-217-8640",
            "fax_number": "909-920-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD L BRUCK M D A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-10",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "BRUCK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-217-8640",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G30560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Upland, CA
• Providers in Upland, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.