Provider Demographics
NPI:1659443976
Name:BRUCE L BOROS MD PA
Entity type:Organization
Organization Name:BRUCE L BOROS MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:305-295-3331
Mailing Address - Street 1:3401 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4238
Mailing Address - Country:US
Mailing Address - Phone:305-295-3331
Mailing Address - Fax:305-295-3387
Practice Address - Street 1:3401 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4238
Practice Address - Country:US
Practice Address - Phone:305-295-3331
Practice Address - Fax:305-295-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031728174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3434Medicare ID - Type UnspecifiedGROUP IDENTIFIER