Healthcare Provider Details

I. General information

NPI: 1568774909
Provider Name (Legal Business Name): JEROME BOBRUFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 PINE RIDGE RD STE F
NAPLES FL
34109-2002
US

IV. Provider business mailing address

2171 PINE RIDGE RD STE F
NAPLES FL
34109-2002
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-6425
  • Fax: 239-593-3430
Mailing address:
  • Phone: 239-566-6425
  • Fax: 239-593-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberACN348
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: