Healthcare Provider Details

I. General information

NPI: 1699736736
Provider Name (Legal Business Name): BRUCE MARTIN NIGRO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PUMPKIN PL NE
PALM BAY FL
32905-4006
US

IV. Provider business mailing address

2101 PUMPKIN PL NE
PALM BAY FL
32905-4006
US

V. Phone/Fax

Practice location:
  • Phone: 321-412-1705
  • Fax: 321-726-5959
Mailing address:
  • Phone: 321-412-1705
  • Fax: 321-726-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2767
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO2767
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO2767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: