Provider Demographics
NPI:1538390646
Name:BRUCE P DORMAN MD PA
Entity type:Organization
Organization Name:BRUCE P DORMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-714-0276
Mailing Address - Street 1:311 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1933
Mailing Address - Country:US
Mailing Address - Phone:941-714-0276
Mailing Address - Fax:941-714-0294
Practice Address - Street 1:311 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1933
Practice Address - Country:US
Practice Address - Phone:941-714-0276
Practice Address - Fax:941-714-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68759207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME68759OtherSTATE LICENSE NUMBER
FLDP6082OtherRAILROAD MEDICARE
FLDP6082OtherRAILROAD MEDICARE
FLME68759OtherSTATE LICENSE NUMBER