Provider Demographics
NPI:1285733691
Name:BERMUDEZ, RAFAEL R (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:R
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1359 CALLE LUCHETTI
Mailing Address - Street 2:PH 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2025
Mailing Address - Country:US
Mailing Address - Phone:787-725-1603
Mailing Address - Fax:787-721-0439
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:STE 802
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1503
Practice Address - Country:US
Practice Address - Phone:787-725-1603
Practice Address - Fax:787-721-0439
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12053207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020236Medicare ID - Type Unspecified
PRH82111Medicare UPIN