Provider Demographics
NPI:1811915663
Name:BRUCE H BERMAN, PC
Entity type:Organization
Organization Name:BRUCE H BERMAN, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-747-4767
Mailing Address - Street 1:675 W INDIANTOWN RD
Mailing Address - Street 2:SUITW 203
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7548
Mailing Address - Country:US
Mailing Address - Phone:561-747-4767
Mailing Address - Fax:561-575-7545
Practice Address - Street 1:675 W INDIANTOWN RD
Practice Address - Street 2:SUITW 203
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7548
Practice Address - Country:US
Practice Address - Phone:561-747-4767
Practice Address - Fax:561-575-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0057993261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty