Healthcare Provider Details

I. General information

NPI: 1194720987
Provider Name (Legal Business Name): BRUCE JEREMY BERNIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST SUITE 234
DAYTON OH
45415-1180
US

IV. Provider business mailing address

9000 N MAIN ST SUITE 234
DAYTON OH
45415-1180
US

V. Phone/Fax

Practice location:
  • Phone: 937-277-8988
  • Fax: 937-832-2421
Mailing address:
  • Phone: 937-277-8988
  • Fax: 937-832-2421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number35.038152
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: