Provider Demographics
NPI:1114975851
Name:MAURE, BERNARDITA MATOL (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARDITA
Middle Name:MATOL
Last Name:MAURE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:302 FLOWERWOOD DRIVE
Mailing Address - Street 2:APT 1
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324
Mailing Address - Country:US
Mailing Address - Phone:850-663-7559
Mailing Address - Fax:
Practice Address - Street 1:1000 MAIN STREET
Practice Address - Street 2:FLORIDA STATE HOSPITAL
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324-1118
Practice Address - Country:US
Practice Address - Phone:850-663-7559
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME57717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC55212Medicare UPIN