Individual
DR. BRUCE D FAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 MAIN ST, STE 205, DUNEDIN, FL 34698-5848
(727) 734-6516
(727) 734-4516
Mailing address
PO BOX 1074, DUNEDIN, FL 34697-1074
(727) 734-6516
(727) 734-4516
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME72320
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260527900
—
FL
01
—
45040
BCBS OF FL
FL
Enumeration date
07/22/2005
Last updated
08/01/2011
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