Provider Demographics
NPI:1609815695
Name:GOTTLIEB, BRUCE S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:GOTTLIEB
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 1:9301 BOCA GARDENS CIR S
Mailing Address - Street 2:SUITE F
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-1798
Mailing Address - Country:US
Mailing Address - Phone:561-414-9077
Mailing Address - Fax:
Practice Address - Street 1:9301 BOCA GARDENS CIR S
Practice Address - Street 2:SUITE F
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-1798
Practice Address - Country:US
Practice Address - Phone:561-414-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55718207L00000X, 207LA0401X, 208VP0000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B97813Medicare UPIN