Provider Demographics
NPI:1114169810
Name:BERMUDEZ WAGNER, KARLA (MD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:
Last Name:BERMUDEZ WAGNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6651 MAIN STREET
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:832-826-7450
Mailing Address - Fax:832-825-9351
Practice Address - Street 1:6651 MAIN STREET
Practice Address - Street 2:SUITE 1020
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-826-7450
Practice Address - Fax:832-825-9351
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT187105207V00000X
TXQ2102207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology