Healthcare Provider Details

I. General information

NPI: 1750887907
Provider Name (Legal Business Name): MATTHEW JAMES BRUHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 S FLORIDA AVE
LAKELAND FL
33813-2126
US

IV. Provider business mailing address

702 N ALEXANDER ST
PLANT CITY FL
33563-3064
US

V. Phone/Fax

Practice location:
  • Phone: 863-209-7004
  • Fax:
Mailing address:
  • Phone: 813-722-8746
  • Fax: 863-682-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME171916
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: