Provider Demographics
NPI:1730250663
Name:BERMUDEZ, LIDIA ROSA (MD)
Entity type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:ROSA
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 NW 179TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6509
Mailing Address - Country:US
Mailing Address - Phone:305-300-5501
Mailing Address - Fax:305-824-3774
Practice Address - Street 1:8805 NW 179TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6509
Practice Address - Country:US
Practice Address - Phone:305-300-5501
Practice Address - Fax:305-824-3774
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0091458207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7409OtherMEDICARE GROUP PIN
FL68549OtherBLUE CROSS BLUE SHIELD FLA
FLK7409OtherMEDICARE GROUP PIN
FLU4463ZMedicare PIN