Provider Demographics
NPI:1912904905
Name:PHILLIPS, BRUCE W (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:W
Last Name:PHILLIPS
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 1:9960 CENTRAL PARK BLVD N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1759
Mailing Address - Country:US
Mailing Address - Phone:561-226-4180
Mailing Address - Fax:561-226-4199
Practice Address - Street 1:9960 CENTRAL PARK BLVD N
Practice Address - Street 2:SUITE 100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1759
Practice Address - Country:US
Practice Address - Phone:561-226-4180
Practice Address - Fax:561-226-4199
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 508382085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03999OtherBCBS OF FL
NY052EV1OtherEMPIRE BCBS
FL1029466OtherWELLCARE
FLP0003198OtherFLORIDA HEALTHCARE PLUS
FLP510999OtherOPTIMUM
FL046524100Medicaid
NY052EV2OtherEMPIRE BCBS
FLP01318677OtherRR MEDICARE
FL204369OtherAVMED
FL0544936OtherCIGNA
FL5402697OtherAETNA
FLP01269OtherFREEDOM HEALTH
FL05717OtherDIMENSION HEALTH
FLP510999OtherOPTIMUM
NY052EV2OtherEMPIRE BCBS
FL0544936OtherCIGNA
FL03999ZMedicare PIN