MEDICARE: DR. JONATHAN WILLIAM BRUGGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0107X	Retina Specialist (Ophthalmology) Physician	57881	TN
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	ME145189	FL
3	207W00000X	Ophthalmology Physician	ME145189	FL
4	207W00000X	Ophthalmology Physician	57881	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013172105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN WILLIAM BRUGGER M.D.

Provider Business Mailing Address
First Line	:	2401 UNIVERSITY PKWY
Second Line	:	BUILDING 1, SUITE 205
City	:	SARASOTA
State	:	FL
Zip	:	34243-2973
Country	:	US
Telephone Number	:	419-351-1200
Fax Number	:	941-351-1201

Provider Business Practice Location Address
First Line	:	2401 UNIVERSITY PKWY
Second Line	:	BUILDING 1, SUITE 205
City	:	SARASOTA
State	:	FL
Zip	:	34243-2973
Country	:	US
Telephone Number	:	419-351-1200
Fax Number	:	941-351-1201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	09/03/2020

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Directions to “ DR. JONATHAN WILLIAM BRUGGER M.D.” Practice Location

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