Provider Demographics
NPI:1013914001
Name:BERMUDEZ, EDWARD RENAN (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:RENAN
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 1:3920 BEE RIDGE RD
Mailing Address - Street 2:BLDG E, SUITE F-201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2943
Mailing Address - Country:US
Mailing Address - Phone:941-917-8744
Mailing Address - Fax:941-917-8749
Practice Address - Street 1:3920 BEE RIDGE RD
Practice Address - Street 2:BLDG E, SUITE F-201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2943
Practice Address - Country:US
Practice Address - Phone:941-917-8744
Practice Address - Fax:941-917-8749
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60562207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056041300Medicaid
FL056041300Medicaid
12721WMedicare PIN