MEDICARE: DR. ROBERT BRUCE MONDSHINE 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	207W00000X	Ophthalmology Physician	ME25817	FL

General Provider Information

NPI Number	:	1740565043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT BRUCE MONDSHINE M.D.

Provider Business Mailing Address
First Line	:	134 BAL BAY DR
Second Line	:
City	:	BAL HARBOUR
State	:	FL
Zip	:	33154-1311
Country	:	US
Telephone Number	:	305-867-1117
Fax Number	:	305-861-3538

Provider Business Practice Location Address
First Line	:	134 BAL BAY DR
Second Line	:
City	:	BAL HARBOUR
State	:	FL
Zip	:	33154-1311
Country	:	US
Telephone Number	:	305-867-1117
Fax Number	:	305-861-3538

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

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	10/18/2011

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