Healthcare Provider Details

I. General information

NPI: 1972587061
Provider Name (Legal Business Name): BERNARD E. RERRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 ML KING DR.
CENTRAILIA IL
62801
US

IV. Provider business mailing address

938 M L KING DR
CENTRALIA IL
62801-3058
US

V. Phone/Fax

Practice location:
  • Phone: 618-918-2262
  • Fax: 618-918-3623
Mailing address:
  • Phone: 618-918-2262
  • Fax: 618-918-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number036128561
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036128561
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: