Healthcare Provider Details

I. General information

NPI: 1699726125
Provider Name (Legal Business Name): BRUCE M BRENNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW 13TH ST
BOCA RATON FL
33486-2305
US

IV. Provider business mailing address

701 NW 13TH ST
BOCA RATON FL
33486-2305
US

V. Phone/Fax

Practice location:
  • Phone: 619-955-5966
  • Fax:
Mailing address:
  • Phone: 615-955-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME133095
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: