Provider Demographics
NPI:1750658886
Name:ERVIN E. BERNOTUS MD, P.A.
Entity type:Organization
Organization Name:ERVIN E. BERNOTUS MD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BERNOTUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-753-4400
Mailing Address - Street 1:8625 54TH DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9456
Mailing Address - Country:US
Mailing Address - Phone:941-753-4400
Mailing Address - Fax:941-753-4408
Practice Address - Street 1:8625 54TH DR E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9456
Practice Address - Country:US
Practice Address - Phone:941-753-4400
Practice Address - Fax:941-753-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME885502081P0004X, 2081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
48581OtherBCBS
U3452ZOtherMEDICARE ID TYPE UNSPECIFIED
FLH67422Medicare UPIN
FLU3452XMedicare PIN