Healthcare Provider Details

I. General information

NPI: 1346215936
Provider Name (Legal Business Name): JOSE A. BERMUDEZ SEGARRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO SAN PABLO #100 EDIF. DR. ARTURO CADILLA SUITE 408
BAYAMON PR
00961-7028
US

IV. Provider business mailing address

#100 PASEO SAN PABLO SUITE 408
BAYAMON PR
00961-7028
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-1060
  • Fax: 787-785-9421
Mailing address:
  • Phone: 787-787-1060
  • Fax: 787-785-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number9282
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: