| Entity Name: | DEREK BAZEMORE MD INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 22 Mar 2021 (4 years ago) |
| Document Number: | P21000028344 |
| FEI/EIN Number | 86-2960529 |
| Address: | 55 SW 9TH STREET, APT 1405, MIAMI, FL 33130 |
| Mail Address: | 55 SW 9TH STREET, APT 1405, MIAMI, FL 33130 |
| ZIP code: | 33130 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487344875 | 2023-05-10 | 2023-05-10 | 55 SW 9TH ST APT 1405, MIAMI, FL, 331303992, US | 55 SW 9TH ST APT 1405, MIAMI, FL, 331303992, US | |||||||||||||||||
|
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| Phone | +1 917-750-5709 |
Authorized person
| Name | DEREK GLENN BAZEMORE JR. |
| Role | PRESIDENT |
| Phone | 9177505709 |
Taxonomy
| Taxonomy Code | 207PE0004X - Emergency Medical Services (Emergency Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MARRERO, ALEXIS | Agent | 18489 N US HWY 41, #1289, LUTZ, FL 33548 |
| Name | Role | Address |
|---|---|---|
| BAZEMORE, DEREK | President | 55 SW 9TH STREET, #1405 MIAMI, FL 33130 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-03-27 |
| ANNUAL REPORT | 2022-04-11 |
| Domestic Profit | 2021-03-22 |
Date of last update: 13 Feb 2025
Sources: Florida Department of State
