Provider Demographics
NPI:1609007210
Name:BEDARD, YELENA ZOTOVA (MD)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:ZOTOVA
Last Name:BEDARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:VIKTORANA
Other - Last Name:ZOTOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9800 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4039
Mailing Address - Country:US
Mailing Address - Phone:954-755-5504
Mailing Address - Fax:954-755-7052
Practice Address - Street 1:9800 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4039
Practice Address - Country:US
Practice Address - Phone:954-755-5504
Practice Address - Fax:954-755-7052
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
FLME113862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program