MEDICARE: DR. BRUCE W. PHILLIPS 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	2085R0001X	Radiation Oncology Physician	ME 50838	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	P01318677	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03999	OTHER	FL	BCBS OF FL
2	052EV1	OTHER	NY	EMPIRE BCBS
3	1029466	OTHER	FL	WELLCARE
4	P0003198	OTHER	FL	FLORIDA HEALTHCARE PLUS
5	P510999	OTHER	FL	OPTIMUM
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	052EV2	OTHER	NY	EMPIRE BCBS
9	204369	OTHER	FL	AVMED
10	0544936	OTHER	FL	CIGNA
11	5402697	OTHER	FL	AETNA
12	P01269	OTHER	FL	FREEDOM HEALTH
13	05717	OTHER	FL	DIMENSION HEALTH

General Provider Information

NPI Number	:	1912904905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE W. PHILLIPS M.D.

Provider Business Mailing Address
First Line	:	9960 CENTRAL PARK BLVD N
Second Line	:	SUITE 100
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1759
Country	:	US
Telephone Number	:	561-226-4180
Fax Number	:	561-226-4199

Provider Business Practice Location Address
First Line	:	9960 CENTRAL PARK BLVD N
Second Line	:	SUITE 100
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1759
Country	:	US
Telephone Number	:	561-226-4180
Fax Number	:	561-226-4199

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	04/19/2016

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Directions to “ DR. BRUCE W. PHILLIPS M.D.” Practice Location

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