Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | ME98576 | FL |
Y | 207RI0011X | Interventional Cardiology | ME98576 | FL |
NPI | 1073636197 |
---|---|
Provider Name | Edmund A Bermudez |
First Address | Atlanta, GA 30394-7407 |
Second Address | North Venice, FL 34275-3669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09083 | BLUE CROSS BLUE SHIELD (01) | FL |
279605800 | (05) | FL |
7173488 | AETNA (01) | FL |
9430897 | CIGNA (01) | FL |
P00417656 | RAILROAD MEDICARE (01) | FL |