Provider Demographics
NPI:1598777294
Name:BERNADOTTE, OVIDE-HENRI (MD)
Entity Type:Individual
Prefix:
First Name:OVIDE-HENRI
Middle Name:
Last Name:BERNADOTTE
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 1:15451 NATURES POINT LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7159
Mailing Address - Country:US
Mailing Address - Phone:561-753-5986
Mailing Address - Fax:
Practice Address - Street 1:601 W ALVERDEZ AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3504
Practice Address - Country:US
Practice Address - Phone:863-983-1423
Practice Address - Fax:863-983-1426
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME659282084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378694300Medicaid
FL378694300Medicaid
FL27751Medicare ID - Type Unspecified