Individual
BRUCE A. PATZWAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12700 CREEKSIDE LN, SUITE 101, FORT MYERS, FL 33919-3356
(239) 432-0774
(239) 432-9404
Mailing address
632 DEL PRADO BLVD N, SUITE 101, CAPE CORAL, FL 33909-2278
(239) 772-5577
(239) 772-9961
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
PA1782
FL
363AM0700X
Medical Physician Assistant
PA1782
FL
363AS0400X
Surgical Physician Assistant
Primary
PA1782
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2902397-00
—
FL
01
—
Y00LX
BCBS
FL
Enumeration date
04/06/2006
Last updated
02/12/2013
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