MEDICARE: DR. JON C BERNREUTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	9302	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306880364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON C BERNREUTER M.D.

Provider Business Mailing Address
First Line	:	1 W LAKESHORE DR
Second Line	:	STE 100
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-7271
Country	:	US
Telephone Number	:	205-823-7248
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 W LAKESHORE DR STE 100
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-7271
Country	:	US
Telephone Number	:	205-930-2950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/16/2023

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