Organization
ERVIN E. BERNOTUS MD, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERVIN EUGENE BERNOTUS M.D. (PHYSICIAN/OWNER)
(941) 753-4400
Entity
Organization
Contact information
Practice address
8625 54TH DR E, BRADENTON, FL 34211-9456
(941) 753-4400
(941) 753-4408
Mailing address
8625 54TH DR E, BRADENTON, FL 34211-9456
(941) 753-4400
(941) 753-4408
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME88550
FL
2081P0004X
Spinal Cord Injury Medicine Physician
ME88550
FL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
ME88550
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48581
BCBS
—
01
—
U3452Z
MEDICARE ID TYPE UNSPECIFIED
—
Enumeration date
11/17/2011
Last updated
11/17/2011
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