MEDICARE: OSTEOPATHIC MEDICINE TAMPA, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician

General Provider Information

NPI Number	:	1427927094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSTEOPATHIC MEDICINE TAMPA, PLLC

Provider Business Mailing Address
First Line	:	905 W PLATT ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2113
Country	:	US
Telephone Number	:	813-485-5780
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 W PLATT ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2113
Country	:	US
Telephone Number	:	813-485-5780
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	JONATHAN BRUNER
Credential	:	DO
Telephone Number	:	813-478-5780

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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