Provider Demographics
NPI:1760440234
Name:FLETCHER, BRUCE S (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:S
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 COLONIAL DRIVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063
Mailing Address - Country:US
Mailing Address - Phone:954-979-3255
Mailing Address - Fax:954-979-6635
Practice Address - Street 1:5901 COLONIAL DRIVE
Practice Address - Street 2:SUITE #201
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063
Practice Address - Country:US
Practice Address - Phone:954-979-3255
Practice Address - Fax:954-979-6635
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0049995207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E96974Medicare UPIN
FL40539Medicare ID - Type Unspecified
FL1093960001Medicare NSC