Healthcare Provider Details

I. General information

NPI: 1316924806
Provider Name (Legal Business Name): ERIC H BERNICKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 MOUNTAIN VIEW AVE STE 540
LONGMONT CO
80501-3183
US

IV. Provider business mailing address

PO BOX 800022
KANSAS CITY MO
64180-0022
US

V. Phone/Fax

Practice location:
  • Phone: 720-494-7110
  • Fax: 720-494-7111
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberH9796
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberDR.0070375
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: