Individual provider · NPI-1

Dr. David R Bruah, MD

Family Medicine · Port Charlotte, FL

NPI number1962511634
StatusActive
Last updated in NPPESNov 22, 2019

Details

NPI
1962511634
Entity type
Individual (NPI-1)
Name
Dr. David R Bruah
Credential
MD
Sex
Male
Sole proprietor
No
Enumeration date
Aug 29, 2006
Last updated
Nov 22, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineME105412FLYes
207Q00000X Family Medicine036-065568IL

Practice location

21297 Olean Blvd Ste A
Port Charlotte, FL 33952-6704

Phone 855-979-5700

Mailing address

2675 Winkler Ave Fl 2
Fort Myers, FL 33901-9342

Phone 877-856-3774 · Fax 239-599-2625

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