MEDICARE: BRIAN ALLEN BRUCKNER 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	204F00000X	Transplant Surgery Physician	30631	MS
2	204F00000X	Transplant Surgery Physician	66242	TN
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	K7670	TX
4	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	66242	TN
5	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	30631	MS
6	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME141685	FL

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	:	1871573097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN ALLEN BRUCKNER M.D.

Provider Business Mailing Address
First Line	:	2900 CORPORATE WAY
Second Line	:	DOOR D
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3925
Country	:	US
Telephone Number	:	954-276-5685
Fax Number	:	954-985-7074

Provider Business Practice Location Address
First Line	:	1150 N 35TH AVE STE 440
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5430
Country	:	US
Telephone Number	:	954-265-6356
Fax Number	:	954-985-5154

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	09/09/2022

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Directions to “ BRIAN ALLEN BRUCKNER M.D.” Practice Location

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