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General NPI Number Information
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NPI Number | 1750455820
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Entity Type | Individual
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Provider Name | BRIAN WAYNE BOZZA M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 10501 FGCU BLVD S
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City | FORT MYERS
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State | FL
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Zip | 33965-0921
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Country | US
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Telephone | 239-745-4299
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Fax | 239-590-7398
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Provider Business Mailing Address
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Address Line | 3434 HANCOCK BRIDGE PKWY STE. 301
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903-7094
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Country | US
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Telephone | 877-856-3774
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Fax | 239-599-2625
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME80216
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License Number State | FL
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