Provider Demographics
NPI:1922027853
Name:RANKIN, BRUCE GLENN (D O)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:GLENN
Last Name:RANKIN
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 PEACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0834
Mailing Address - Country:US
Mailing Address - Phone:386-740-7080
Mailing Address - Fax:386-734-0821
Practice Address - Street 1:999 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3134
Practice Address - Country:US
Practice Address - Phone:386-740-7080
Practice Address - Fax:386-734-0821
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S6029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82882ZMedicare ID - Type Unspecified
FLD60755Medicare UPIN