Provider Demographics
NPI:1164765012
Name:BARDOS, JONAH DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JONAH
Middle Name:DAVID
Last Name:BARDOS
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 1:19505 BISCAYNE BLVD STE 2230
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2314
Mailing Address - Country:US
Mailing Address - Phone:305-526-4530
Mailing Address - Fax:305-985-5815
Practice Address - Street 1:19505 BISCAYNE BLVD STE 2230
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2314
Practice Address - Country:US
Practice Address - Phone:305-526-4530
Practice Address - Fax:305-985-5815
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131429207V00000X, 207VE0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME131429OtherMEDICAL LICENSE