Provider Demographics
NPI:1467486803
Name:LERMAN, BRUCE IAN (DPM)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:IAN
Last Name:LERMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 KNOWLES DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1542
Mailing Address - Country:US
Mailing Address - Phone:408-379-8450
Mailing Address - Fax:408-379-2672
Practice Address - Street 1:555 KNOWLES DR STE 117
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1542
Practice Address - Country:US
Practice Address - Phone:408-379-8450
Practice Address - Fax:408-379-2672
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E29960213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0999680001Medicare NSC
CA000E29960Medicare UPIN