Provider Demographics
NPI:1184627382
Name:BRONISCER, ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:
Last Name:BRONISCER
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 1:262 DANNY THOMAS PLACE, MS 0515
Mailing Address - Street 2:ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PLACE, MS 0515
Practice Address - Street 2:ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN363982080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009905345Medicaid
IA563072Medicaid
MN360488800Medicaid
KY64056849Medicaid
OH2524085Medicaid
MT0071961Medicaid
IN200400610AMedicaid
MS00126518Medicaid
NJ0030341Medicaid
MO205951007Medicaid
KS200336060AMedicaid
TN3496709Medicaid
MI104677849Medicaid
LA1136395Medicaid
AZ804030Medicaid
OK100847840AMedicaid
GA186358377AMedicaid
ME422400000Medicaid
IN200400610AMedicaid