Basic Information
| Provider Information | |||||||||
| NPI: | 1093826521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAND | ||||||||
| FirstName: | BRUCE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 W BERYL AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850211606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024396780 | ||||||||
| FaxNumber: | 6024674733 | ||||||||
| Practice Location | |||||||||
| Address1: | 4045 E BELL RD | ||||||||
| Address2: | SUITE 139 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029968888 | ||||||||
| FaxNumber: | 6029922280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 11/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 1841 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1Z1370 | 01 | AZ | HEALTHNET | OTHER | 232380 | 05 | AZ | MEDICAID | AZ0068280 | 01 | AZ | BCBS | OTHER |