Provider Demographics
NPI:1811183965
Name:SILVA BERMUDEZ, JUAN JOSE (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:JOSE
Last Name:SILVA 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 1:1486 AVE F.D. ROOSEVELT
Mailing Address - Street 2:APT. 1201
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2741
Mailing Address - Country:US
Mailing Address - Phone:787-599-5571
Mailing Address - Fax:
Practice Address - Street 1:1486 AVE F.D. ROOSEVELT
Practice Address - Street 2:APT. 1201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2741
Practice Address - Country:US
Practice Address - Phone:787-599-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20582207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHF715AOtherMEDICARE ID