Provider Demographics
NPI:1588744569
Name:BRUNO, JOHN SALVATORE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SALVATORE
Last Name:BRUNO
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 1:2685 SWAMP CABBAGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9331
Mailing Address - Country:US
Mailing Address - Phone:239-936-2522
Mailing Address - Fax:239-936-7831
Practice Address - Street 1:2685 SWAMP CABBAGE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9331
Practice Address - Country:US
Practice Address - Phone:239-936-2522
Practice Address - Fax:239-936-7831
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131832086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15670OtherFLORIDA WELLCARE
FL242907206OtherRAILROAD MEDICARE
FL591745972OtherTAX ID #
FL055527400Medicaid
FLD58416OtherUPIN
FL78251OtherMEDICARE PROVIDER NUMBER