Provider Demographics
NPI:1700396637
Name:BERMUDEZ MEDICAL GROUP, LLC.
Entity Type:Organization
Organization Name:BERMUDEZ MEDICAL GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-300-5501
Mailing Address - Street 1:2601 DAVIE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-3029
Mailing Address - Country:US
Mailing Address - Phone:305-300-5501
Mailing Address - Fax:305-383-7408
Practice Address - Street 1:2601 DAVIE BLVD STE B
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-3029
Practice Address - Country:US
Practice Address - Phone:305-300-5501
Practice Address - Fax:305-383-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty