Provider Demographics
NPI:1134162563
Name:BRUCE, JARROD THOMAS (MD, FCCP)
Entity type:Individual
Prefix:DR
First Name:JARROD
Middle Name:THOMAS
Last Name:BRUCE
Suffix:
Gender:M
Credentials:MD, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 E MAIN ST
Mailing Address - Street 2:PO BOX 2563
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4056
Mailing Address - Country:US
Mailing Address - Phone:740-687-8990
Mailing Address - Fax:740-687-8230
Practice Address - Street 1:618 PLEASANTVILLE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3312
Practice Address - Country:US
Practice Address - Phone:740-689-6833
Practice Address - Fax:740-689-6827
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.085971207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2619321Medicaid
OHH018320Medicare PIN
OH2619321Medicaid
OH2619321Medicaid
OHH018320Medicare PIN