Provider Demographics
NPI:1760642375
Name:B BRUCE MYERS MD PA
Entity Type:Organization
Organization Name:B BRUCE MYERS MD PA
Other - Org Name:B BRUCE MYERS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-391-9661
Mailing Address - Street 1:2900 N MILITARY TRL
Mailing Address - Street 2:SUITE 247
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6365
Mailing Address - Country:US
Mailing Address - Phone:561-391-9661
Mailing Address - Fax:561-391-8981
Practice Address - Street 1:2900 N MILITARY TRL
Practice Address - Street 2:SUITE 247
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6365
Practice Address - Country:US
Practice Address - Phone:561-391-9661
Practice Address - Fax:561-391-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68376207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF84177Medicare UPIN
FL49937Medicare PIN