Healthcare Provider Details

I. General information

NPI: 1578562575
Provider Name (Legal Business Name): BRUCE M WENIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DRIVE MOFFITT CANCER CENTER - 2ND FLOOR, RM 2049
TAMPA FL
33612
US

IV. Provider business mailing address

PO BOX 198441 MOFFITT CANCER CENTER - 2ND FLOOR RM 2049
ATLANTA GA
30384-8441
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-2213
  • Fax: 813-745-1708
Mailing address:
  • Phone: 813-745-7365
  • Fax: 813-449-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME60205
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number153567
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: