Healthcare Provider Details

I. General information

NPI: 1386794337
Provider Name (Legal Business Name): JOSE A BERMUDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HALL ST
MONROE LA
71201-7526
US

IV. Provider business mailing address

200 HENRY CLAY AVE
NEW ORLEANS LA
70118-5720
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-6565
  • Fax: 318-966-6566
Mailing address:
  • Phone: 504-896-9568
  • Fax: 504-896-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number05360R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: