Provider Demographics
NPI:1265568109
Name:DORMAN, BRUCE P (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:P
Last Name:DORMAN
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 1:311 MANATEE AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1933
Mailing Address - Country:US
Mailing Address - Phone:941-714-0276
Mailing Address - Fax:941-714-0294
Practice Address - Street 1:311 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1933
Practice Address - Country:US
Practice Address - Phone:941-714-0276
Practice Address - Fax:941-714-0294
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068759207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00083OtherUNIVERSAL
FL2511849OtherGHI
FL650766854001OtherMEDICAL MUTUAL
FL710389OtherUPMC
FL5815156OtherCIGNA
FLAA2970OtherHARVARD PILGRIM HPHC
FL379114900Medicaid
FL15563OtherSTAYWELL/HEALTHEASE/WELLC
FL5328057OtherAETNA
FL00040840001OtherUNIVERA
FL106832OtherHEALTHPARTNERS
FL27454OtherBCBS
FLFL0009578OtherTRICARE
FLP0072875OtherRAILROAD MEDICARE
FL5328057OtherAETNA
FL5815156OtherCIGNA
FL379114900Medicaid