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General NPI Number Information
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NPI Number | 1427115823
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Entity Type | Individual
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Provider Name | DUSTIN MIGUEL BERMUDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 517 MOYE BLVD FL 1 ECU PHYSICIANS SURGERY, MOYE MEDICAL CENTER #2
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City | GREENVILLE
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State | NC
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Zip | 27834-2849
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Country | US
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Telephone | 252-744-2393
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Fax | 252-744-0018
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Provider Business Mailing Address
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Address Line | PO BOX 751069
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City | CHARLOTTE
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State | NC
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Zip | 28275-1069
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MT187077
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2012-00109
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License Number State | NC
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