Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 2005-00626 | NC |
N | 207ND0101X | MOHS-Micrographic Surgeon | 2005-00626 | NC |
NPI | 1003895004 |
---|---|
Provider Name | Rene Bermudez |
First Address | Wilmington, NC 28401-7346 |
Second Address | Whiteville, NC 28472-3706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I3318 | (02) | NC |