Provider Demographics
NPI:1548213648
Name:ERNST, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ERNST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-1907
Mailing Address - Country:US
Mailing Address - Phone:813-548-1100
Mailing Address - Fax:813-548-1152
Practice Address - Street 1:3527 LITTLE RD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1811
Practice Address - Country:US
Practice Address - Phone:727-849-5502
Practice Address - Fax:727-849-0926
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066477207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE90871Medicare UPIN
FL25380AMedicare ID - Type Unspecified
FLK2110AMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL25380BMedicare ID - Type Unspecified
FLK2110Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER