| Bruce A Isaacson Md Pc | |
|
550 E 1400 N Suite Z Logan UT 84341-2406 | |
| (435) 755-5799 | |
| (435) 755-5839 |
| Full Name | Bruce A Isaacson Md Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 550 E 1400 N, Logan, Utah |
| Authorized Official Name and Position | Bruce Isaacson (OWNER) |
| Authorized Official Contact | 4357555799 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce A Isaacson Md Pc 550 E 1400 N Suite Z Logan UT 84341-2406 Ph: (435) 755-5799 | Bruce A Isaacson Md Pc 550 E 1400 N Suite Z Logan UT 84341-2406 Ph: (435) 755-5799 |
| NPI Number | 1952716755 |
|---|---|
| Provider Enumeration Date | 07/01/2014 |
| Last Update Date | 07/01/2014 |
| Medicare PECOS PAC ID | 8820217516 |
|---|---|
| Medicare Enrollment ID | O20140911000003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952716755 | NPI | - | NPPES |
| 528845794041 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 1780691205 (Utah) | Primary |
| Provider Name | Bruce A Isaacson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881762649 PECOS PAC ID: 8527233923 Enrollment ID: I20111214000243 |
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