=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912091141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERNHARD BRIJBAG, D.O., P,A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 03/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1150 CAMPO SANO AVE SUITE 420
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-1174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-663-0088
-----------------------------------------------------
Fax | 305-663-1193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5000 UNIVERSITY DR STE 1100
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-663-0088
-----------------------------------------------------
Fax | 305-663-1193
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. BERNHARD L BRIJBAG
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 305-663-0088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | OS0007081
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------