Individual
DR. DAVID R BRUAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
21297 OLEAN BLVD STE A, PORT CHARLOTTE, FL 33952-6704
(855) 979-5700
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774
(239) 599-2625
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036-065568
IL
207Q00000X
Family Medicine Physician
Primary
ME105412
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065568 1
—
IL
Enumeration date
08/29/2006
Last updated
11/22/2019
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