Healthcare Provider Details

I. General information

NPI: 1306896246
Provider Name (Legal Business Name): STEPHEN THOMAS BERNARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEPHEN W. BERNARD M.D.

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S SCHWARTZ AVE STE 202
FARMINGTON NM
87401-5925
US

IV. Provider business mailing address

PO BOX 844088
DALLAS TX
75284-4088
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6770
  • Fax: 505-609-6775
Mailing address:
  • Phone: 505-609-2258
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD27814
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD2018-0925
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: