Provider Demographics
NPI:1285607911
Name:MANN, BRUCE M (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:M
Last Name:MANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 223190
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33022-3190
Mailing Address - Country:US
Mailing Address - Phone:305-974-5533
Mailing Address - Fax:305-974-5553
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:UNIT 212
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:305-974-5533
Practice Address - Fax:305-974-5553
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME71254207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252615800Medicaid
FL32413VMedicare ID - Type Unspecified
G45608Medicare UPIN
FL252615800Medicaid