Healthcare Provider Details

I. General information

NPI: 1467408682
Provider Name (Legal Business Name): JACK E BERNDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 SW CHANDLER AVE
BEND OR
97702-3615
US

IV. Provider business mailing address

1715 SW CHANDLER AVE
BEND OR
97702-3615
US

V. Phone/Fax

Practice location:
  • Phone: 541-588-5620
  • Fax: 888-625-0286
Mailing address:
  • Phone: 541-588-5620
  • Fax: 888-625-0286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD25340
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number2026010959
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026010959
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD25340
License Number StateOR
# 5
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number2026010959
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: