1659549335 NPI number — BRUCE M FROME, MD, INC.

Table of content: (NPI 1659549335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659549335 NPI number — BRUCE M FROME, MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRUCE M FROME, MD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659549335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90209-1157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-288-5959
Provider Business Mailing Address Fax Number:
310-288-5950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 N CRESCENT DR
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90210-4860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-288-5968
Provider Business Practice Location Address Fax Number:
310-288-5950
Provider Enumeration Date:
02/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FROME
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
310-288-5968

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  G8667 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208D00000X , with the licence number: G8667 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)