Healthcare Provider Details

I. General information

NPI: 1548228729
Provider Name (Legal Business Name): BRUCE WILLIAM ZUKERBERG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13590 JOG RD STE 4-5
DELRAY BEACH FL
33446-3807
US

IV. Provider business mailing address

13590 JOG RD STE 4-5
DELRAY BEACH FL
33446-3807
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-0833
  • Fax:
Mailing address:
  • Phone: 561-496-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME68493
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: