1265568109 NPI number — BRUCE P DORMAN MD

Table of content: BRUCE P DORMAN MD (NPI 1265568109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265568109 NPI number — BRUCE P DORMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DORMAN
Provider First Name:
BRUCE
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1265568109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 MANATEE AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34208-1933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-714-0276
Provider Business Mailing Address Fax Number:
941-714-0294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 MANATEE AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34208-1933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-714-0276
Provider Business Practice Location Address Fax Number:
941-714-0294
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  ME0068759 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00083 . This is a "UNIVERSAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2511849 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650766854001 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 710389 . This is a "UPMC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5815156 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: AA2970 . This is a "HARVARD PILGRIM HPHC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 379114900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15563 . This is a "STAYWELL/HEALTHEASE/WELLC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5328057 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00040840001 . This is a "UNIVERA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 106832 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 27454 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: FL0009578 . This is a "TRICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P0072875 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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