Provider Demographics
NPI:1093912172
Name:REYES FERNANDEZ, BERNARDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:J
Last Name:REYES FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BERNARDO
Other - Middle Name:JOSE
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2950 CLEVELAND CLINIC BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3609
Mailing Address - Country:US
Mailing Address - Phone:954-659-5000
Mailing Address - Fax:954-659-5354
Practice Address - Street 1:2950 CLEVELAND CLINIC BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3609
Practice Address - Country:US
Practice Address - Phone:954-659-5000
Practice Address - Fax:954-659-5354
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24140208M00000X, 207R00000X
FLME 120914207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00904484Medicare PIN
RE4297171Medicare PIN