Healthcare Provider Details

I. General information

NPI: 1477882876
Provider Name (Legal Business Name): PETER BERNAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2559 MEDICAL DR SUITE G
ALAMOGORDO NM
88310-8703
US

IV. Provider business mailing address

2559 MEDICAL DR SUITE G
ALAMOGORDO NM
88310-8703
US

V. Phone/Fax

Practice location:
  • Phone: 575-437-8216
  • Fax: 575-437-8205
Mailing address:
  • Phone: 575-437-8216
  • Fax: 575-437-8205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberNM 2009-0729
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberNM 2009-0729
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: