Organization
BRADENTON EAST MEDICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELSY RUCKER M.D. (PRESIDENT)
(941) 727-1243
Entity
Organization
Contact information
Practice address
6120 53RD AVE E, BRADENTON, FL 34203-9707
(941) 727-1243
Mailing address
6120 53RD AVE E, BRADENTON, FL 34203-9707
(941) 727-1243
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21621
BCBS FLORIDA GROUP NUMBER
FL
Enumeration date
10/06/2006
Last updated
08/22/2020
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