Healthcare Provider Details

I. General information

NPI: 1003849258
Provider Name (Legal Business Name): BRUCE H BERMAN,MD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W INDIANTOWN RD SUITE 100
JUPITER FL
33458-7548
US

IV. Provider business mailing address

675 W INDIANTOWN RD SUITE 100
JUPITER FL
33458-7548
US

V. Phone/Fax

Practice location:
  • Phone: 561-935-1090
  • Fax: 561-935-1080
Mailing address:
  • Phone: 561-935-1090
  • Fax: 561-935-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME 0057993
License Number StateFL

VIII. Authorized Official

Name: BRUCE HAL BERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 561-935-1090