Healthcare Provider Details

I. General information

NPI: 1659549335
Provider Name (Legal Business Name): BRUCE M FROME, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N CRESCENT DR SUITE 230
BEVERLY HILLS CA
90210-4860
US

IV. Provider business mailing address

PO BOX 15157
BEVERLY HILLS CA
90209-1157
US

V. Phone/Fax

Practice location:
  • Phone: 310-288-5968
  • Fax: 310-288-5950
Mailing address:
  • Phone: 310-288-5959
  • Fax: 310-288-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG8667
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG8667
License Number StateCA

VIII. Authorized Official

Name: DR. BRUCE M FROME
Title or Position: PRESIDENT
Credential: MD
Phone: 310-288-5968