Provider Demographics
NPI:1790770204
Name:BRUKOFF, CHRISTOPHER D (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:BRUKOFF
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 1:2653 STICKNEY POINT RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6019
Mailing Address - Country:US
Mailing Address - Phone:941-342-8200
Mailing Address - Fax:941-342-8201
Practice Address - Street 1:2653 STICKNEY POINT RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6019
Practice Address - Country:US
Practice Address - Phone:941-342-8200
Practice Address - Fax:941-342-8201
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67900207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27078OtherBLUE CROSS BLUE SHIELD
FL378760500Medicaid
FL378760500Medicaid
FL27078ZMedicare ID - Type Unspecified