Provider Demographics
NPI:1558301101
Name:BRYAN J WASSERMAN MD PA
Entity Type:Organization
Organization Name:BRYAN J WASSERMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-498-7501
Mailing Address - Street 1:5258 LINTON BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6540
Mailing Address - Country:US
Mailing Address - Phone:561-357-9204
Mailing Address - Fax:
Practice Address - Street 1:5258 LINTON BLVD
Practice Address - Street 2:STE 305
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6540
Practice Address - Country:US
Practice Address - Phone:561-498-7501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0784OtherGROUP NUMBER