Provider Demographics
NPI:1790845378
Name:SHUSTER, BERNARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:A
Last Name:SHUSTER
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 1:4001 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6792
Mailing Address - Country:US
Mailing Address - Phone:954-961-5500
Mailing Address - Fax:954-961-7171
Practice Address - Street 1:4001 HOLLYWOOD BOULEVARD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6792
Practice Address - Country:US
Practice Address - Phone:954-961-5500
Practice Address - Fax:954-961-7171
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68121173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47858Medicare ID - Type Unspecified
FLG45241Medicare UPIN