Healthcare Provider Details

I. General information

NPI: 1962936856
Provider Name (Legal Business Name): PAUL DAVID BERNDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W GLYNN DR
PARKSTON SD
57366-9605
US

IV. Provider business mailing address

401 W GLYNN DR
PARKSTON SD
57366-9605
US

V. Phone/Fax

Practice location:
  • Phone: 605-928-7961
  • Fax: 605-928-4417
Mailing address:
  • Phone: 605-928-7961
  • Fax: 605-928-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12083
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: