MEDICARE: JAIRO L BERMUDEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	K2848	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	00621F	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1578550919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIRO L BERMUDEZ MD

Provider Business Mailing Address
First Line	:	301 JENNY GEORGE LN
Second Line	:	STE A
City	:	SWEETWATER
State	:	TX
Zip	:	79556-7145
Country	:	US
Telephone Number	:	325-235-0770
Fax Number	:	325-235-0771

Provider Business Practice Location Address
First Line	:	4414 NORTH FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77022-3654
Country	:	US
Telephone Number	:	888-663-6331
Fax Number	:	415-252-7176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	04/17/2025

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Directions to “ JAIRO L BERMUDEZ MD” Practice Location

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