Provider Demographics
NPI:1699736736
Name:NIGRO, BRUCE MARTIN (DPM)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MARTIN
Last Name:NIGRO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 PUMPKIN PL NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4006
Mailing Address - Country:US
Mailing Address - Phone:321-412-1705
Mailing Address - Fax:321-726-5959
Practice Address - Street 1:2101 PUMPKIN PL NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4006
Practice Address - Country:US
Practice Address - Phone:321-412-1705
Practice Address - Fax:321-726-5959
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2767213E00000X, 213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65242OtherBCBS
FL340491900Medicaid
FL65242OtherBCBS
FLU16087Medicare UPIN