Healthcare Provider Details

I. General information

NPI: 1265525919
Provider Name (Legal Business Name): BERNHARDT ANDERSON MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 PARKLAWN DRIVE SUITE 101
MIDWEST CITY OK
73110-4211
US

IV. Provider business mailing address

2801 PARKLAWN DRIVE SUITE 101
MIDWEST CITY OK
73110-4211
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-6691
  • Fax: 405-737-7723
Mailing address:
  • Phone: 405-737-6691
  • Fax: 405-737-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7275
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number7275
License Number StateOK

VIII. Authorized Official

Name: DR. WILLIAM GENE BERNHARDT
Title or Position: PRESIDENT PHYSICIAN
Credential: MD
Phone: 405-737-6691