Bruce Devon, M.D., P.C. – Urology Physician

Key facts

NPI: 1639201429
Entity type: Organization (NPI type 2)
Primary specialty: Urology Physician 208800000X
License: 42568 (MA)
Legal business name: BRUCE DEVON, M.D., P.C.
Practice address: 8 Porter St
Melrose, MA 02176-2824
Phone: (617) 387-3851
Fax: (781) 979-0555
NPI assigned: Mar 9, 2007
Organization subpart: No

Authorized official

Name: Bruce Devon, MD NPI 1205849155
Title: President
Phone: (617) 387-3851

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Bruce Devon, M.D. Urology Physician · Melrose, MA · NPI 1205849155

NPD (past) Authorized official UROLOGY

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Urology Physician Group: 193400000X SINGLE SPECIALTY GROUP	208800000X	42568	MA	Yes

Addresses

Primary practice location

8 Porter St
Melrose, MA 02176-2824

Mailing address

8 Porter St
Melrose, MA 02176-2824
Phone (617) 387-3851

Other identifiers

Identifier	Type	State	Issuer
2060574	Medicaid	MA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639201429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 PORTER ST",
            "city": "MELROSE",
            "state": "MA",
            "postal_code": "021762824",
            "telephone_number": "617-387-3851",
            "fax_number": "781-979-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 PORTER ST",
            "city": "MELROSE",
            "state": "MA",
            "postal_code": "021762824",
            "telephone_number": "617-387-3851",
            "fax_number": "781-979-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE DEVON, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEVON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-387-3851",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "MA",
            "license": "42568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2060574",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Melrose, MA

All providers in Melrose, MA · Urology Physician in Massachusetts

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.