Provider Demographics
NPI:1548585102
Name:BERMUDEZ, FERNANDO EDGARDO (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:EDGARDO
Last Name: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 1:2700 UNIVERSITY SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5513
Mailing Address - Country:US
Mailing Address - Phone:813-253-2721
Mailing Address - Fax:813-253-2299
Practice Address - Street 1:1700 S. TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3555
Practice Address - Country:US
Practice Address - Phone:941-917-7322
Practice Address - Fax:813-253-2299
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1246402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015129900Medicaid
FLIQ473ZMedicare PIN
FLIQ473YMedicare PIN