Provider Demographics
NPI:1447448592
Name:LRB MEDICAL SERVICES P A
Entity type:Organization
Organization Name:LRB MEDICAL SERVICES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-300-5501
Mailing Address - Street 1:8805 NW 179TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6509
Mailing Address - Country:US
Mailing Address - Phone:305-300-5501
Mailing Address - Fax:305-824-3774
Practice Address - Street 1:8805 NW 179TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-6509
Practice Address - Country:US
Practice Address - Phone:305-300-5501
Practice Address - Fax:305-824-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0091458208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68549OtherBLUE CROSS BLUE SHIELD FLA
FL68549OtherBLUE CROSS BLUE SHIELD FLA
FLU4463ZMedicare PIN