Provider Demographics
NPI:1780781138
Name:BERMUDEZ, ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERTO
Other - Middle Name:
Other - Last Name:BERMUDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:28652 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1215
Mailing Address - Country:US
Mailing Address - Phone:305-247-0018
Mailing Address - Fax:305-247-0078
Practice Address - Street 1:28652 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1215
Practice Address - Country:US
Practice Address - Phone:305-247-0018
Practice Address - Fax:305-247-0078
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274826174OtherEIN
FLH76459Medicare UPIN