Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 35.038152 | OH |
NPI | 1194720987 |
---|---|
Provider Name | Dr. Bruce Jeremy Bernie |
First Address | Dayton, OH 45415-1180 |
Second Address | Dayton, OH 45415-1180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 07/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0332456 | (05) | OH |
A75390 | (02) | OH |