Individual
BRUCE M KISKADDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
43309 US HIGHWAY 19 N, TARPON SPRINGS, FL 34689-6221
(727) 943-3111
(727) 943-3334
Mailing address
43309 US HIGHWAY 19 N, TARPON SPRINGS, FL 34689-6221
(727) 943-3111
(727) 943-3334
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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