Provider Demographics
NPI:1053399071
Name:MATHER, BRUCE S (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:MATHER
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 CORPORATE PARK DR
Practice Address - Street 2:SUITE 200 & 300
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7134
Practice Address - Country:US
Practice Address - Phone:704-235-9090
Practice Address - Fax:704-235-9101
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128YUMedicaid
NCH48274Medicare UPIN
NC2288376AMedicare ID - Type Unspecified