Provider Demographics
NPI:1578562575
Name:WENIG, BRUCE M (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:M
Last Name:WENIG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198441 MOFFITT CANCER CENTER - 2ND FLOOR RM 2049
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8441
Mailing Address - Country:US
Mailing Address - Phone:813-745-7365
Mailing Address - Fax:813-449-8618
Practice Address - Street 1:12902 USF MAGNOLIA DRIVE
Practice Address - Street 2:MOFFITT CANCER CENTER - 2ND FLOOR, RM 2049
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-745-2213
Practice Address - Fax:813-745-1708
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60205207ZP0101X
NY153567207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02237281Medicaid
NY9059275252OtherNGS
NY905921Medicare ID - Type Unspecified
NY02237281Medicaid
NY9059270211Medicare PIN