Healthcare Provider Details

I. General information

NPI: 1174875074
Provider Name (Legal Business Name): BRADLEY R. BUGHER PA-AA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 N FEDERAL HWY
FORT LAUDERDALE FL
33308-4603
US

IV. Provider business mailing address

PO BOX 551420
FORT LAUDERDALE FL
33355-1420
US

V. Phone/Fax

Practice location:
  • Phone: 954-493-5005
  • Fax: 954-938-0957
Mailing address:
  • Phone: 800-243-3839
  • Fax: 855-851-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberANT.0000199
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA259
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: