Provider Demographics
NPI:1861483505
Name:BERMUDEZ, ZAIDA C (MD)
Entity Type:Individual
Prefix:
First Name:ZAIDA
Middle Name:C
Last Name:BERMUDEZ
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 1:5032 SAN MASSIMO DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-8059
Mailing Address - Country:US
Mailing Address - Phone:941-575-1514
Mailing Address - Fax:941-639-0466
Practice Address - Street 1:350 MARY ST
Practice Address - Street 2:SUITE A
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4564
Practice Address - Country:US
Practice Address - Phone:941-575-1514
Practice Address - Fax:941-639-0466
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061355000Medicaid
FL061355000Medicaid
FL08134Medicare PIN