Healthcare Provider Details

I. General information

NPI: 1881679546
Provider Name (Legal Business Name): HANS ALLEN BERNDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7955 SPYGLASS HILL RD STE B
MELBOURNE FL
32940-8249
US

IV. Provider business mailing address

7955 SPYGLASS HILL RD STE A
MELBOURNE FL
32940-8249
US

V. Phone/Fax

Practice location:
  • Phone: 321-255-6670
  • Fax: 321-242-2545
Mailing address:
  • Phone: 321-255-6670
  • Fax: 321-775-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME138288
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8561
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: