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General NPI Number Information
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NPI Number | 1285619221
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Entity Type | Individual
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Provider Name | BRUCE V OUELLETTE M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 10000 SW INNOVATION WAY
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-2111
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Country | US
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Telephone | 954-345-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 383 SE MULBERRY WAY
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City | PORT ST LUCIE
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State | FL
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Zip | 34984-2310
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Country | US
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Telephone | 850-865-2644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME84932
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License Number State | FL
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