Provider Demographics
NPI:1760480842
Name:FARISS, BRUCE (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:FARISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:819 PEACOCK PLZ
Mailing Address - Street 2:BOX 903
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4255
Mailing Address - Country:US
Mailing Address - Phone:305-296-0000
Mailing Address - Fax:305-296-0002
Practice Address - Street 1:3714 N ROOSEVELT BLVD
Practice Address - Street 2:SUITE 640
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4533
Practice Address - Country:US
Practice Address - Phone:305-296-0000
Practice Address - Fax:305-296-0002
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME95170208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68287OtherBLUE CROSS
FL68287OtherBLUE CROSS
FLF92798Medicare UPIN