MEDICARE: BRUCE JOSTEN D.O.P.A.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1447521232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE JOSTEN D.O.P.A.

Provider Business Mailing Address
First Line	:	2622 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2622 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4311
Country	:	US
Telephone Number	:	850-784-3621
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	BRUCE JOSTEN
Credential	:
Telephone Number	:	850-784-3621

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	02/13/2012

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