Provider Demographics
NPI:1073636197
Name:BERMUDEZ, EDMUND A (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:A
Last Name:BERMUDEZ
Suffix:
Gender:M
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 947407
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-7407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:200 HEALTHCARE WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-3669
Practice Address - Country:US
Practice Address - Phone:941-261-0160
Practice Address - Fax:941-261-0165
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98576207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7173488OtherAETNA
FL9430897OtherCIGNA
FL279605800Medicaid
FLP00417656OtherRAILROAD MEDICARE
FL09083OtherBLUE CROSS BLUE SHIELD
FLP00417656OtherRAILROAD MEDICARE