Individual
DR. BRUCE GORDON SOMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3601 SW 160TH AVE, SUITE 250, MIRAMAR, FL 33027-6308
(877) 866-7123
Mailing address
PO BOX 44008, UFJP PROVIDER ENROLLMENT, JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
204F00000X
Transplant Surgery Physician
ME91422
FL
207Q00000X
Family Medicine Physician
Primary
68000
GA
208600000X
Surgery Physician
ME91422
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2733951-00
—
FL
05
—
518717157A
—
GA
Enumeration date
07/18/2006
Last updated
10/29/2012
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