Provider Demographics
NPI:1790779320
Name:STEIN, BRUCE C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:C
Last Name:STEIN
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 1:1745 N MILLS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4504
Mailing Address - Country:US
Mailing Address - Phone:407-841-7151
Mailing Address - Fax:407-648-2259
Practice Address - Street 1:1745 N MILLS AVENUE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4504
Practice Address - Country:US
Practice Address - Phone:407-841-7151
Practice Address - Fax:407-648-2259
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80836207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4373YMedicare PIN
FLE4373ZMedicare PIN
G94088Medicare UPIN
FLE4373ZMedicare PIN