Individual
BRUCE BENJAMINE WHITNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1540 S TAMIAMI TRL, SUITE 303, SARASOTA, FL 34239-2921
(941) 917-8791
(941) 917-8793
Mailing address
PO BOX 863407, ORLANDO, FL 32886-0001
(941) 917-2600
(941) 917-7884
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
9102589
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982893319
—
MO
05
—
200597730 A
—
KS
01
—
970000095
MEDICARE PROVIDER NO
AS
Enumeration date
10/22/2007
Last updated
11/22/2011
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