Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | M15080 | ID |
NPI | 1003820465 |
---|---|
Provider Name | Dr. John V Bernard |
First Address | Coeur D Alene, ID 83814-6051 |
Second Address | Belvidere, NJ 07823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 01/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E23199 | (02) |