Provider Demographics
NPI:1538257894
Name:BRUIJN, LUCY LAN (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:LAN
Last Name:BRUIJN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:LUCY
Other - Middle Name:LAN
Other - Last Name:BUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:4095 AMERICAN WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-8339
Mailing Address - Country:US
Mailing Address - Phone:901-275-9500
Mailing Address - Fax:865-342-0120
Practice Address - Street 1:4095 AMERICAN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-8339
Practice Address - Country:US
Practice Address - Phone:901-275-9500
Practice Address - Fax:865-342-0120
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD42205207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD42205OtherTN MEDICAL LICENSE
HIMD 13499OtherMEDICAL LICENSE
NMMD2007-0450OtherSTATE LIC
TNMD42205OtherTN MEDICAL LICENSE