Provider Demographics
NPI:1386794337
Name:BERMUDEZ, JOSE A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 HENRY CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5720
Mailing Address - Country:US
Mailing Address - Phone:504-896-9568
Mailing Address - Fax:504-896-3966
Practice Address - Street 1:301 HALL ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7526
Practice Address - Country:US
Practice Address - Phone:318-966-6565
Practice Address - Fax:318-966-6566
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA05360R207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1312011Medicaid
LA1312011Medicaid
56626Medicare ID - Type Unspecified