Provider Demographics
NPI:1841263779
Name:BRUCK, DARREN (MD)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:BRUCK
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 1:7300 N KENDALL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7840
Mailing Address - Country:US
Mailing Address - Phone:305-925-8118
Mailing Address - Fax:305-925-8119
Practice Address - Street 1:9299 SW 152ND ST STE 104
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1775
Practice Address - Country:US
Practice Address - Phone:305-925-8118
Practice Address - Fax:305-925-8119
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92733208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003183700Medicaid
FLU5590ZMedicare PIN
FL003183700Medicaid