Provider Demographics
NPI: | 1881679546 |
---|---|
Name: | BERNDES, HANS ALLEN (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | HANS |
Middle Name: | ALLEN |
Last Name: | BERNDES |
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: | 7955 SPYGLASS HILL RD STE A |
Mailing Address - Street 2: | |
Mailing Address - City: | MELBOURNE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32940-8249 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 321-255-6670 |
Mailing Address - Fax: | 321-775-1364 |
Practice Address - Street 1: | 7955 SPYGLASS HILL RD STE B |
Practice Address - Street 2: | |
Practice Address - City: | MELBOURNE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32940-8249 |
Practice Address - Country: | US |
Practice Address - Phone: | 321-255-6670 |
Practice Address - Fax: | 321-242-2545 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-12-14 |
Last Update Date: | 2022-03-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | ME138288 | 207L00000X |
NV | 8561 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NV | 1881679546 | Medicaid | |
FL | 27867 | Other | BCBS |
NE | 002002605 | Medicaid | |
OH | 10194100001 | Other | OHIO WC |
NV | G61695 | Medicare UPIN |