Provider Demographics
NPI:1710052097
Name:BRUNO, JORGE CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:CESAR
Last Name:BRUNO
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 1:5858 SW 68 ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3693
Mailing Address - Country:US
Mailing Address - Phone:305-661-8588
Mailing Address - Fax:305-661-4906
Practice Address - Street 1:5858 SW 68 ST
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3693
Practice Address - Country:US
Practice Address - Phone:305-661-8588
Practice Address - Fax:305-661-4906
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99381207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280981800Medicaid
C28438Medicare UPIN
FL280981800Medicaid