Provider Demographics
NPI:1003849258
Name:BRUCE H BERMAN,MD,PA
Entity Type:Organization
Organization Name:BRUCE H BERMAN,MD,PA
Other - Org Name:PALM BEACH HOLISTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:HAL
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-935-1090
Mailing Address - Street 1:675 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7548
Mailing Address - Country:US
Mailing Address - Phone:561-935-1090
Mailing Address - Fax:561-935-1080
Practice Address - Street 1:675 W INDIANTOWN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7548
Practice Address - Country:US
Practice Address - Phone:561-935-1090
Practice Address - Fax:561-935-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0057993261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC34038Medicare UPIN