Provider Demographics
NPI:1598724445
Name:BERMUDEZ, OVIDIO BERNABE (MD)
Entity Type:Individual
Prefix:DR
First Name:OVIDIO
Middle Name:BERNABE
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 1:8140 E 5TH AVENUE
Mailing Address - Street 2:EATING RECOVERY CENTER
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6492
Mailing Address - Country:US
Mailing Address - Phone:918-671-7393
Mailing Address - Fax:303-364-1812
Practice Address - Street 1:8140 E 5TH AVENUE
Practice Address - Street 2:EATING RECOVERY CENTER
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6492
Practice Address - Country:US
Practice Address - Phone:918-671-7393
Practice Address - Fax:303-364-1812
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO492982080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200055420AMedicaid
2238093OtherCIGNA BEHAVIORAL HEALTH
4220021OtherAETNA BEHAVIORAL HEALTH
OKC76562Medicare UPIN
2238093OtherCIGNA BEHAVIORAL HEALTH