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NPI Code Detail

MEDICARE: DAVID L. BERNDT DO PA

MEDICARE: DAVID L. BERNDT DO PA
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
1261QP2300XPrimary Care Clinic/CenterOS3372FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
181878OTHERFLBCBS

General Provider Information

NPI Number : 1740573179
Entity Type Code : Organization
Provider Name (Legal Business Name) : DAVID L. BERNDT DO PA
Provider Business Mailing Address
First Line : 5930 SW 64 AVE
Second Line :
City : DAVIE
State : FL
Zip : 33314
Country : US
Telephone Number : 954-791-7101
Fax Number : 954-791-2521
Provider Business Practice Location Address
First Line : 5930 SW 64TH AVE
Second Line :
City : DAVIE
State : FL
Zip : 33314-7116
Country : US
Telephone Number : 954-791-7101
Fax Number : 954-791-2521
Authorized Official
Title or Position : MEDICAL ASSISTANT
Name : JENNY MARTINEZ
Credential :
Telephone Number : 954-791-7101
Provider Enumeration Date : 05/18/2011
Last Update Date : 05/18/2011

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Directions to “DAVID L. BERNDT DO PA ” Practice Location

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