Healthcare Provider Details

I. General information

NPI: 1750658886
Provider Name (Legal Business Name): ERVIN E. BERNOTUS MD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8625 54TH DR E
BRADENTON FL
34211-9456
US

IV. Provider business mailing address

8625 54TH DR E
BRADENTON FL
34211-9456
US

V. Phone/Fax

Practice location:
  • Phone: 941-753-4400
  • Fax: 941-753-4408
Mailing address:
  • Phone: 941-753-4400
  • Fax: 941-753-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME88550
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberME88550
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME88550
License Number StateFL

VIII. Authorized Official

Name: DR. ERVIN EUGENE BERNOTUS
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 941-753-4400