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General NPI Number Information
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NPI Number | 1598937104
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Entity Type | Organization
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Legal Business Name | BRUCE A RODAN MD PA
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 111 WATERBRIDGE LN
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City | JUPITER
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State | FL
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Zip | 33458-7743
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Country | US
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Telephone | 561-575-7123
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Fax | 561-745-7440
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Provider Business Mailing Address
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Address Line | 111 WATERBRIDGE LN
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City | JUPITER
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State | FL
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Zip | 33458-7743
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Country | US
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Telephone | 561-575-7123
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Fax | 561-745-7440
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE ALAN RODAN
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Credential | M.D.
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Telephone | 561-575-7123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME037878
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License Number State | FL
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