Basic Information
| Provider Information | |||||||||
| NPI: | 1285607911 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANN | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 223190 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330223190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059745533 | ||||||||
| FaxNumber: | 3059745553 | ||||||||
| Practice Location | |||||||||
| Address1: | 5841 S CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059745533 | ||||||||
| FaxNumber: | 3059745553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2006 | ||||||||
| LastUpdateDate: | 04/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME71254 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | ME71254 | FL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.