Healthcare Provider Details

I. General information

NPI: 1790066967
Provider Name (Legal Business Name): JOHN S. BRUNO, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 SWAMP CABBAGE CT
FORT MYERS FL
33901-9331
US

IV. Provider business mailing address

2685 SWAMP CABBAGE CT
FORT MYERS FL
33901-9331
US

V. Phone/Fax

Practice location:
  • Phone: 239-936-2522
  • Fax: 239-936-7831
Mailing address:
  • Phone: 239-936-2522
  • Fax: 239-936-7831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME13183
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN S. BRUNO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 239-936-2522