MEDICARE: DR. BEDFORD HUDSON BERREY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	ME74636	FL
2	2086X0206X	Surgical Oncology Physician	ME74636	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	200044245	OTHER	RR CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114988409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEDFORD HUDSON BERREY MD

Provider Business Mailing Address
First Line	:	PO BOX 45278
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32232-5278
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-393-7603

Provider Business Practice Location Address
First Line	:	1301 PALM AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8432
Country	:	US
Telephone Number	:	904-202-7300
Fax Number	:	904-202-7433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	12/11/2019

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