Provider Demographics
NPI:1770949653
Name:WYMAN, BRUCE (HIS)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:WYMAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FUNDY RD STE 100
Mailing Address - Street 2:FALMOUTH HEARING AIDS
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1777
Mailing Address - Country:US
Mailing Address - Phone:207-541-9295
Mailing Address - Fax:207-541-9296
Practice Address - Street 1:4 FUNDY RD STE 100
Practice Address - Street 2:FALMOUTH HEARING AIDS
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1777
Practice Address - Country:US
Practice Address - Phone:207-541-9295
Practice Address - Fax:207-541-9296
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDL371246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other