MEDICARE: BRUCE FARISS MD

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	208800000X	Urology Physician	ME95170	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68287	OTHER	FL	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760480842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE FARISS MD

Provider Business Mailing Address
First Line	:	819 PEACOCK PLZ
Second Line	:	BOX 903
City	:	KEY WEST
State	:	FL
Zip	:	33040-4255
Country	:	US
Telephone Number	:	305-296-0000
Fax Number	:	305-296-0002

Provider Business Practice Location Address
First Line	:	3714 N ROOSEVELT BLVD
Second Line	:	SUITE 640
City	:	KEY WEST
State	:	FL
Zip	:	33040-4533
Country	:	US
Telephone Number	:	305-296-0000
Fax Number	:	305-296-0002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	11/24/2010

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Directions to “ BRUCE FARISS MD” Practice Location

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