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Individual
BRUCE M KISKADDON
Active
Individual
BRUCE M KISKADDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME35851
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0027100
GHI
—
01
—
202008
AMERIGROUP
FL
01
—
209961
AVMED
FL
01
—
484087
CIGNA
FL
01
—
51112
BCBS
FL
Enumeration date
09/01/2005
Last updated
04/16/2008
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