Provider Demographics
NPI:1356451140
Name:BRUCE SELDEN MD PA
Entity Type:Organization
Organization Name:BRUCE SELDEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-752-4377
Mailing Address - Street 1:2855 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-1405
Mailing Address - Country:US
Mailing Address - Phone:954-752-4377
Mailing Address - Fax:954-752-7585
Practice Address - Street 1:2855 N UNIVERSITY DR
Practice Address - Street 2:SUITE 300
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-1405
Practice Address - Country:US
Practice Address - Phone:954-752-4377
Practice Address - Fax:954-752-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 24902207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26528300Medicaid
78177ZMedicare ID - Type Unspecified
FL26528300Medicaid