Provider Demographics
NPI:1740573179
Name:DAVID L. BERNDT DO PA
Entity Type:Organization
Organization Name:DAVID L. BERNDT DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-791-7101
Mailing Address - Street 1:5930 SW 64 AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314
Mailing Address - Country:US
Mailing Address - Phone:954-791-7101
Mailing Address - Fax:954-791-2521
Practice Address - Street 1:5930 SW 64TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7116
Practice Address - Country:US
Practice Address - Phone:954-791-7101
Practice Address - Fax:954-791-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3372261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81878OtherBCBS
FLD27332Medicare UPIN