Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME74636 | FL |
Y | 2086X0206X | Surgical Oncologist | ME74636 | FL |
NPI | 1114988409 |
---|---|
Provider Name | Dr. Bedford Hudson Berrey |
First Address | Jacksonville, FL 32232-5278 |
Second Address | Jacksonville, FL 32207-8432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 11/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000809718B | (05) | GA |
200044245 | RR CARE (01) | |
2505126-00 | (05) | FL |
B97764 | (02) | FL |