Provider Demographics
NPI:1770508731
Name:BERMUDEZ, JOSE M (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:BERMUDEZ
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 1:16023 SW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-3833
Mailing Address - Country:US
Mailing Address - Phone:305-553-5003
Mailing Address - Fax:305-553-6156
Practice Address - Street 1:11333 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1148
Practice Address - Country:US
Practice Address - Phone:305-553-5003
Practice Address - Fax:305-553-6156
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL83795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264429100Medicaid
FLE7705XMedicare PIN
FLH64982Medicare UPIN
FLE7705Medicare PIN