Healthcare Provider Details

I. General information

NPI: 1033434204
Provider Name (Legal Business Name): BRUCE I LERMAN DPM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 KNOWLES DR STE 117
LOS GATOS CA
95032-1542
US

IV. Provider business mailing address

555 KNOWLES DR STE 117
LOS GATOS CA
95032-1542
US

V. Phone/Fax

Practice location:
  • Phone: 408-379-8450
  • Fax: 408-379-2672
Mailing address:
  • Phone: 408-292-8800
  • Fax: 408-292-8809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000E29960
License Number StateCA

VIII. Authorized Official

Name: BRUCE IAN LERMAN
Title or Position: OWNER
Credential: DPM
Phone: 408-379-8450