MEDICARE: DR. BRYAN J WASSERMAN MD

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	207R00000X	Internal Medicine Physician	ME39253	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K0784	OTHER	FL	GROUP

General Provider Information

NPI Number	:	1700832664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN J WASSERMAN MD

Provider Business Mailing Address
First Line	:	5258 LINTON BLVD
Second Line	:	STE 305
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6540
Country	:	US
Telephone Number	:	561-498-7501
Fax Number	:

Provider Business Practice Location Address
First Line	:	5258 LINTON BLVD
Second Line	:	STE 305
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6540
Country	:	US
Telephone Number	:	561-498-7501
Fax Number	:

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	04/08/2013

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