Provider Demographics
NPI:1639122880
Name:RAMSHAW, BRUCE JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JOHN
Last Name:RAMSHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11945 SAN JOSE BLVD
Mailing Address - Street 2:BLDG 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:904-399-1717
Practice Address - Street 1:201 N CLYDE MORRIS BLVD.
Practice Address - Street 2:SUITE 205
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2765
Practice Address - Country:US
Practice Address - Phone:386-259-8326
Practice Address - Fax:386-310-1827
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME108729208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142AL2OtherBCBSFL
FL142AL2OtherBCBSFL
F81687Medicare UPIN