Healthcare Provider Details

I. General information

NPI: 1811915663
Provider Name (Legal Business Name): BRUCE H BERMAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W INDIANTOWN RD SUITW 203
JUPITER FL
33458-7548
US

IV. Provider business mailing address

675 W INDIANTOWN RD SUITW 203
JUPITER FL
33458-7548
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-4767
  • Fax: 561-575-7545
Mailing address:
  • Phone: 561-747-4767
  • Fax: 561-575-7545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME 0057993
License Number StateFL

VIII. Authorized Official

Name: BRUCE H. BERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 561-747-4767