Provider Demographics
NPI:1821319989
Name:BERMEJO, LEONIDES D (MD)
Entity Type:Individual
Prefix:MS
First Name:LEONIDES
Middle Name:D
Last Name:BERMEJO
Suffix:
Gender:F
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:PO BOX 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-623-2426
Mailing Address - Fax:501-623-2405
Practice Address - Street 1:1 MERCY LN STE 505
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6462
Practice Address - Country:US
Practice Address - Phone:501-623-2426
Practice Address - Fax:501-623-2405
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK277352084N0400X
ARE-86402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR204513001Medicaid
AR204513001Medicaid