Individual
ANNE W BRUCKER-BUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1425 MALABAR RD NE, PALM BAY, FL 32907-2506
(321) 434-8078
(321) 434-8075
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1981
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
10155
MT
207R00000X
Internal Medicine Physician
43191
WI
207R00000X
Internal Medicine Physician
60074658
WA
207R00000X
Internal Medicine Physician
ME124930
FL
208M00000X
Hospitalist Physician
Primary
ME124930
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016887700
—
FL
01
—
IL931Z
MEDICARE
FL
Enumeration date
07/26/2006
Last updated
12/18/2017
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