Provider Demographics
NPI:1356683767
Name:LOPEZ BERMUDEZ, FELIX I (MD)
Entity Type:Individual
Prefix:MR
First Name:FELIX
Middle Name:I
Last Name:LOPEZ 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 1:12301 LAKE UNDERHILL ROAD
Mailing Address - Street 2:STE 223-27
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4512
Mailing Address - Country:US
Mailing Address - Phone:407-720-3045
Mailing Address - Fax:407-720-3042
Practice Address - Street 1:12301 LAKE UNDERHILL ROAD
Practice Address - Street 2:STE 223-27
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4512
Practice Address - Country:US
Practice Address - Phone:407-720-3045
Practice Address - Fax:407-720-3042
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-24
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124778208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL5472775OtherDEA