Provider Demographics
NPI:1548497662
Name:BERMUDEZ, CONRADO SAUL (MD)
Entity type:Individual
Prefix:DR
First Name:CONRADO
Middle Name:SAUL
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11735 SW 147TH AVE UNIT 16
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3330
Mailing Address - Country:US
Mailing Address - Phone:786-233-6981
Mailing Address - Fax:786-322-2317
Practice Address - Street 1:11735 SW 147TH AVE UNIT 16
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3330
Practice Address - Country:US
Practice Address - Phone:786-953-8200
Practice Address - Fax:786-953-8247
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME106084OtherFAMILY MEDICINE