Provider Demographics
NPI:1679740765
Name:EVELYN BERNE, MD
Entity Type:Organization
Organization Name:EVELYN BERNE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BREAST SURGICAL ONCOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-530-8566
Mailing Address - Street 1:350 NW 84TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1817
Mailing Address - Country:US
Mailing Address - Phone:954-370-7555
Mailing Address - Fax:954-370-7554
Practice Address - Street 1:350 NW 84TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1817
Practice Address - Country:US
Practice Address - Phone:954-370-7555
Practice Address - Fax:954-370-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1168312086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z769Medicare PIN