Provider Demographics
NPI:1538180278
Name:JANSEN, BRUCE M (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:JANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PROSPECT AVENUE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323
Mailing Address - Country:US
Mailing Address - Phone:814-437-5776
Mailing Address - Fax:814-437-5304
Practice Address - Street 1:150 PROSPECT AVENUE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323
Practice Address - Country:US
Practice Address - Phone:814-437-5776
Practice Address - Fax:814-437-5304
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044671L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA88833Medicare ID - Type Unspecified
F18677Medicare UPIN