Healthcare Provider Details

I. General information

NPI: 1649233396
Provider Name (Legal Business Name): JAY GARY BERNSTEIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 W BETHANY HOME RD
PHOENIX AZ
85019-1808
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 623-281-1258
  • Fax: 623-281-1260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1936
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: