Provider Demographics
NPI:1578562575
Name:WENIG, BRUCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:WENIG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12902 USF MAGNOLIA DRIVE
Mailing Address - Street 2:MOFFITT CANCER CENTER - 2ND FLOOR, RM 2049
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:813-745-2213
Mailing Address - Fax:813-745-1708
Practice Address - Street 1:12902 USF MAGNOLIA DRIVE
Practice Address - Street 2:MOFFITT CANCER CENTER - 2ND FLOOR, RM 2049
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-745-2213
Practice Address - Fax:813-745-1708
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY153567207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02237281Medicaid
NY9059275252OtherNGS
NY905921Medicare ID - Type Unspecified
NY02237281Medicaid
NY9059270211Medicare PIN