Healthcare Provider Details

I. General information

NPI: 1003923129
Provider Name (Legal Business Name): JAMES W BERNARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W 12TH ST
CARUTHERSVILLE MO
63830-1890
US

IV. Provider business mailing address

PO BOX 201
CARUTHERSVILLE MO
63830-0201
US

V. Phone/Fax

Practice location:
  • Phone: 573-333-1782
  • Fax: 573-333-4665
Mailing address:
  • Phone: 573-333-1782
  • Fax: 573-333-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberR2470
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: