Bruce R Wymore, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

36058 Issued in MN

Practice address

610 30TH Ave West
Alexandria Clinic
Alexandria, MN 56308

Phone

(320) 763-5123

Fax

(320) 763-7883

NPI assigned

Jan 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Douglas County Hospital

  • Family Medicine Physician
  • Alexandria, MN
  • NPI 1447526330
  NPD

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376006400000",
    "number": "1285614149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 30TH AVE WEST",
            "address_2": "ALEXANDRIA CLINIC",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "56308",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-7883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 30TH AVE WEST",
            "address_2": "ALEXANDRIA CLINIC",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "56308",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-7883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMORE",
        "first_name": "BRUCE",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-18",
        "last_updated": "2013-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "36058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080059897",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114578900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Woodland Dentistry
• McKayla Woods, APRN
• Kristin Wright
• Jared Wunderlich
• Katherine Wussow
• Joseph Robert Wymore, OTR/L
• Paul W Wysoski, OD
• Jason Cole Yager
• Thomas V. Yager
• Young at Heart Dentistry

• Family Medicine Physician in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2013; 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.