Healthcare Provider Details

I. General information

NPI: 1629071261
Provider Name (Legal Business Name): BRUCE I HINDIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 SOUTH STATE ROAD 7 STE 110
WELLINGTON FL
33414-9323
US

IV. Provider business mailing address

2585 SOUTH STATE ROAD 7 STE 110
WELLINGTON FL
33414-9323
US

V. Phone/Fax

Practice location:
  • Phone: 561-795-8655
  • Fax: 561-795-3275
Mailing address:
  • Phone: 561-795-8655
  • Fax: 561-795-3275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS04484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: