Healthcare Provider Details

I. General information

NPI: 1417963778
Provider Name (Legal Business Name): MAURICIO BERMUDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 CORTEZ BLVD STE 102
BROOKSVILLE FL
34613-6897
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 305
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-7660
  • Fax: 352-596-5581
Mailing address:
  • Phone: 352-277-5348
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME81584
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: