Provider Demographics
NPI:1780687608
Name:NAKFOOR, BRUCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:NAKFOOR
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 1:340 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-8798
Mailing Address - Country:US
Mailing Address - Phone:239-470-4048
Mailing Address - Fax:
Practice Address - Street 1:8625 COLLIER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-3550
Practice Address - Country:US
Practice Address - Phone:239-429-0100
Practice Address - Fax:239-241-8209
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00707172085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00790OtherUNV. HLTH CR. PROVIDER #
FL207227OtherAMERIGROUP GROUP #
FL250234800Medicaid
FL67147OtherOP. ENG. LOC. 825 PROV. #
FL211577OtherAVMED PROVIDER NUMBER
FL2951592-019OtherCIGNA PROVIDER NUMBER
FL24-05763OtherUTD. HLTHCR. PROVIDER #
FL16857OtherWELLCARE-MEDICAID/MEDICARE
FL8226OtherAVMED PIN NUMBER
FL5819288OtherAETNA PROVIDER #
FL2951592-019OtherCIGNA PROVIDER NUMBER
FL8226OtherAVMED PIN NUMBER