Provider Demographics
NPI:1306869391
Name:NUSSBAUM, CHRIS (MD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 MORFIELD LN
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6336
Mailing Address - Country:US
Mailing Address - Phone:813-508-1640
Mailing Address - Fax:813-571-5789
Practice Address - Street 1:510 VONDERBURG DRIVE
Practice Address - Street 2:SUITE 213
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5979
Practice Address - Country:US
Practice Address - Phone:813-508-1640
Practice Address - Fax:813-571-5789
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51407Medicare UPIN