Healthcare Provider Details

I. General information

NPI: 1598724445
Provider Name (Legal Business Name): OVIDIO BERNABE BERMUDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 E 5TH AVENUE EATING RECOVERY CENTER
DENVER CO
80230-6492
US

IV. Provider business mailing address

8140 E 5TH AVENUE EATING RECOVERY CENTER
DENVER CO
80230-6492
US

V. Phone/Fax

Practice location:
  • Phone: 918-671-7393
  • Fax: 303-364-1812
Mailing address:
  • Phone: 918-671-7393
  • Fax: 303-364-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number49298
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: