Provider Demographics
NPI:1568436400
Name:BRONSON, ERIC DONALD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DONALD
Last Name:BRONSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 TOWN CENTER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3639
Mailing Address - Country:US
Mailing Address - Phone:954-349-2345
Mailing Address - Fax:954-641-1080
Practice Address - Street 1:1600 TOWN CENTER BLVD STE C
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3641
Practice Address - Country:US
Practice Address - Phone:954-389-5900
Practice Address - Fax:954-389-5751
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102094363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002876700OtherGROUP MEDICAID
FL002602400Medicaid
FL002876700OtherGROUP MEDICAID
K0493OtherGROUP MEDICARE PTAN
FL002602400Medicaid
U1464ZMedicare PIN
K0493OtherGROUP MEDICARE PTAN