MEDICARE: JUAN JOSE SILVA BERMUDEZ M.D.

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	20582	PR
2	208D00000X	General Practice Physician	20582	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HF715A	OTHER	PR	MEDICARE ID

General Provider Information

NPI Number	:	1811183965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN JOSE SILVA BERMUDEZ M.D.

Provider Business Mailing Address
First Line	:	1486 AVE F.D. ROOSEVELT
Second Line	:	APT. 1201
City	:	SAN JUAN
State	:	PR
Zip	:	00920-2741
Country	:	US
Telephone Number	:	787-599-5571
Fax Number	:

Provider Business Practice Location Address
First Line	:	1486 AVE F.D. ROOSEVELT
Second Line	:	APT. 1201
City	:	SAN JUAN
State	:	PR
Zip	:	00920-2741
Country	:	US
Telephone Number	:	787-599-5571
Fax Number	:

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

Provider Enumeration Date	:	09/22/2007
Last Update Date	:	07/11/2013

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