Provider Demographics
NPI:1578550919
Name:BERMUDEZ, JAIRO L (MD)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:L
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 1:301 JENNY GEORGE LN
Mailing Address - Street 2:STE A
Mailing Address - City:SWEETWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79556-7145
Mailing Address - Country:US
Mailing Address - Phone:325-235-0770
Mailing Address - Fax:325-235-0771
Practice Address - Street 1:3828 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7048
Practice Address - Country:US
Practice Address - Phone:512-443-1311
Practice Address - Fax:512-448-8203
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK2848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046361405Medicaid
TX046361406Medicaid
TX046361403Medicaid
TX00621FOtherBCBS
TX046361405Medicaid
TX046361406Medicaid
TX00621FOtherBCBS
TX314310YKXVMedicare PIN