Provider Demographics
NPI:1548268998
Name:MERTZ, BRUCE LEIGHTON (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:LEIGHTON
Last Name:MERTZ
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 1:203 WALLS DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7022
Mailing Address - Country:US
Mailing Address - Phone:817-645-2070
Mailing Address - Fax:817-645-2055
Practice Address - Street 1:203 WALLS DR
Practice Address - Street 2:SUITE 204
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7022
Practice Address - Country:US
Practice Address - Phone:817-645-2070
Practice Address - Fax:817-645-2055
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0024BKMedicare ID - Type Unspecified