Provider Demographics
NPI:1194962761
Name:BRUCE, THOMAS PETER (PSYD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PETER
Last Name:BRUCE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2199 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5232
Mailing Address - Country:US
Mailing Address - Phone:305-444-0403
Mailing Address - Fax:305-444-0403
Practice Address - Street 1:2199 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5232
Practice Address - Country:US
Practice Address - Phone:305-444-0403
Practice Address - Fax:305-444-0403
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75755Medicare PIN