Individual
DR. GEORGE THOMAS BERNARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
790 DUNLAWTON AVE, SUITE E, PORT ORANGE, FL 32127-9279
(386) 760-1877
(386) 760-2791
Mailing address
790 DUNLAWTON AVE, SUITE E, PORT ORANGE, FL 32127-9279
(386) 760-1877
(386) 760-2791
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0056972
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051717800
—
FL
01
—
0551243
AETNA
FL
01
—
080164320
RAILROAD MEDICARE
FL
01
—
45360
MEDICARE GROUP
FL
01
—
59-3667262
TAX ID#
FL
Enumeration date
09/25/2006
Last updated
10/26/2009
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