Healthcare Provider Details

I. General information

NPI: 1780635508
Provider Name (Legal Business Name): MARK STEVEN BERNARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E HERNDON AVE
FRESNO CA
93720-3309
US

IV. Provider business mailing address

PO BOX 6102
NOVATO CA
94948-6102
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-3109
  • Fax:
Mailing address:
  • Phone: 415-884-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License NumberA66845
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberA66845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: