Provider Demographics
NPI:1174614853
Name:BEARISON, FRED (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:BEARISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 LITHIA CENTER LN
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5676
Mailing Address - Country:US
Mailing Address - Phone:813-662-0123
Mailing Address - Fax:813-662-9422
Practice Address - Street 1:315 75TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3201
Practice Address - Country:US
Practice Address - Phone:941-792-2211
Practice Address - Fax:855-622-2362
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103839000Medicaid
FLD56658Medicare UPIN