Healthcare Provider Details

I. General information

NPI: 1245216340
Provider Name (Legal Business Name): BRUCE KEITH BOHNKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9210 FLORIDA PALM DR
TAMPA FL
33619-4352
US

IV. Provider business mailing address

9210 FLORIDA PALM DR
TAMPA FL
33619-4352
US

V. Phone/Fax

Practice location:
  • Phone: 813-246-4377
  • Fax: 813-246-4654
Mailing address:
  • Phone: 813-246-4377
  • Fax: 813-246-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberME043317
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME043317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: