Healthcare Provider Details

I. General information

NPI: 1174579536
Provider Name (Legal Business Name): BRUCE LAWRENCE SALTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 N FEDERAL HWY E 102
BOCA RATON FL
33431-5188
US

IV. Provider business mailing address

4800 N FEDERAL HWY SUITE E - 102
BOCA RATON FL
33431-5188
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-8430
  • Fax: 561-362-5575
Mailing address:
  • Phone: 561-368-8430
  • Fax: 561-362-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0056515
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME0056515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: