| Bruce Wishnov Do Pa | |
|
22065 State Road 7 Boca Raton FL 33428-4219 | |
| (561) 488-4847 | |
| (561) 488-4366 |
| Full Name | Bruce Wishnov Do Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 22065 State Road 7, Boca Raton, Florida |
| Authorized Official Name and Position | Bruce Wishnov (PRESIDENT) |
| Authorized Official Contact | 5614884847 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce Wishnov Do Pa 22065 State Road 7 Boca Raton FL 33428-4219 Ph: (561) 488-4847 | Bruce Wishnov Do Pa 22065 State Road 7 Boca Raton FL 33428-4219 Ph: (561) 488-4847 |
| NPI Number | 1316014590 |
|---|---|
| Provider Enumeration Date | 11/30/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5991870925 |
|---|---|
| Medicare Enrollment ID | O20080826000378 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316014590 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Florida) | Primary |
| Provider Name | Bruce Wishnov |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134296395 PECOS PAC ID: 2860417680 Enrollment ID: I20080826000371 |
| Provider Name | Leanne N Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568897791 PECOS PAC ID: 7012141765 Enrollment ID: I20131011000459 |
| Provider Name | Anne Carballo Mon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225510985 PECOS PAC ID: 3779821764 Enrollment ID: I20190218001355 |
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