Provider Demographics
NPI:1790066967
Name:JOHN S. BRUNO, M.D., P.A.
Entity Type:Organization
Organization Name:JOHN S. BRUNO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-936-2522
Mailing Address - Street 1:2685 SWAMP CABBAGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9331
Mailing Address - Country:US
Mailing Address - Phone:239-936-2522
Mailing Address - Fax:239-936-7831
Practice Address - Street 1:2685 SWAMP CABBAGE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9331
Practice Address - Country:US
Practice Address - Phone:239-936-2522
Practice Address - Fax:239-936-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131832086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15670OtherWELLCARE
FL242907206OtherMEDICARE RAILROAD
FL78251OtherMEDICARE
FL055527400Medicaid
FL055527400Medicaid