Bruce A. Patzwahl, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA1782 Issued in FL

Practice address

12700 Creekside LN
Suite 101
Fort Myers, FL 33919-3356

Phone

(239) 432-0774

Fax

(239) 432-9404

NPI assigned

Apr 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360627200000",
    "number": "1194787804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 DEL PRADO BLVD N",
            "address_2": "SUITE 101",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339092278",
            "telephone_number": "239-772-5577",
            "fax_number": "239-772-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 CREEKSIDE LN",
            "address_2": "SUITE 101",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339193356",
            "telephone_number": "239-432-0774",
            "fax_number": "239-432-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATZWAHL",
        "first_name": "BRUCE",
        "middle_name": "A.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2013-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA1782",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "FL",
            "license": "PA1782",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA1782",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2902397-00",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y00LX",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott B Patterson, D.O.
• Valerie Patterson, COTA
• Jean Patton, BA
• Kelsey Patton, RN BSN, MSNA
• Nilima A. Patwardhan, M.D.
• Neil E. Pauker, M.D.
• Paul S Decarlo Jr. D.D.S., P.a.
• Josette Paul-Dorestin
• Charlene Paul, LPN
• James Joseph Paul

• All providers in Fort Myers, FL
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.