MEDICARE: DR. BRUCE JOSTEN D.O.

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	207Q00000X	Family Medicine Physician	OS5074	FL

General Provider Information

NPI Number	:	1720145881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE JOSTEN D.O.

Provider Business Mailing Address
First Line	:	2622 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4311
Country	:	US
Telephone Number	:	850-784-3621
Fax Number	:	850-784-9682

Provider Business Practice Location Address
First Line	:	2622 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4311
Country	:	US
Telephone Number	:	850-784-3621
Fax Number	:	850-784-9682

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

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	07/08/2007

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