MEDICARE: DR. MARK H BRUS 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	ME69127	FL
2	208000000X	Pediatrics Physician	ME69127	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00100540	OTHER	FL	RAILROAD MEDICARE

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
2	27964	OTHER	FL	BCBS
3	650512900027	OTHER	FL	TRICARE
4	4088305-002	OTHER	FL	CIGNA

General Provider Information

NPI Number	:	1922097948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK H BRUS MD

Provider Business Mailing Address
First Line	:	PO BOX 863407
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32886-3407
Country	:	US
Telephone Number	:	941-917-2600
Fax Number	:	941-917-7884

Provider Business Practice Location Address
First Line	:	5880 RAND BLVD
Second Line	:	SUITE 200
City	:	SARASOTA
State	:	FL
Zip	:	34238-5118
Country	:	US
Telephone Number	:	941-923-5882
Fax Number	:	941-923-1453

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	06/27/2014

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Directions to “ DR. MARK H BRUS MD” Practice Location

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