Provider Demographics
NPI:1457386229
Name:NOLAN, BRUCE ANDREW (MD, FACP)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:ANDREW
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 NW 9TH AVE
Mailing Address - Street 2:SLEEP DISORDERS CENTER
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1407
Mailing Address - Country:US
Mailing Address - Phone:305-243-5195
Mailing Address - Fax:305-243-5304
Practice Address - Street 1:1501 NW 9TH AVE
Practice Address - Street 2:SLEEP DISORDERS CENTER
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1407
Practice Address - Country:US
Practice Address - Phone:305-243-5195
Practice Address - Fax:305-243-5304
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 130352084N0400X
FLME00130352084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049716900Medicaid
FL40198Medicare UPIN
FL90743XMedicare ID - Type Unspecified