Individual provider · NPI-1

Bruce Bostom, Physicians Assistant

Physician Assistant · Ft Lauderdale, FL

NPI number1881707156
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1881707156
Entity type
Individual (NPI-1)
Name
Mr. Bruce Bostom
Credential
Physicians Assistant
Sex
Male
Sole proprietor
No
Enumeration date
Aug 17, 2006
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician AssistantPA3374FLYes

Practice location

6550 N Federal Hwy
Suite 512
Ft Lauderdale, FL 33308-1404

Phone 954-267-8777 · Fax 954-772-7801

Mailing address

Po Box 70533
Ft Lauderdale, FL 33307-0533

Phone 954-267-8777 · Fax 954-772-7801

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Physician Assistant providers in Ft Lauderdale, FL