Provider Demographics
NPI:1619993375
Name:PALEY, BRUCE HENRY (DO)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:HENRY
Last Name:PALEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 OLD MOULTRIE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4168
Mailing Address - Country:US
Mailing Address - Phone:904-824-8088
Mailing Address - Fax:904-826-4105
Practice Address - Street 1:1851 OLD MOULTRIE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4168
Practice Address - Country:US
Practice Address - Phone:904-824-8088
Practice Address - Fax:904-826-4105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5622207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
593157956OtherHUMANA
0709348001OtherCIGNA
FL80532OtherBLUE CROSS
FL0898894OtherAETNA
FL317938300Medicaid
4394237OtherAETNA
FL024544400Medicaid
101894OtherAVMED
80532OtherBLUE CROSS BLUE SHIELD
593157956OtherUNITED HEALTHCARE