=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790066967
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN S. BRUNO, M.D., P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2011
-----------------------------------------------------
Last Update Date | 09/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2685 SWAMP CABBAGE CT
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33901-9331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-936-2522
-----------------------------------------------------
Fax | 239-936-7831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2685 SWAMP CABBAGE CT
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33901-9331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-936-2522
-----------------------------------------------------
Fax | 239-936-7831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN S. BRUNO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 239-936-2522
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | ME13183
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------