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General NPI Number Information
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NPI Number | 1073738373
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Entity Type | Individual
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Provider Name | JEREMIA DOUGLAS BERNHARDT MD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 1401 MADISON ST SUITE 100
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City | SEATTLE
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State | WA
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Zip | 98104-1316
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Country | US
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Telephone | 206-386-6111
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Fax | 206-386-6113
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Provider Business Mailing Address
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Address Line | 15721 ASHWORTH AVE N
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City | SHORELINE
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State | WA
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Zip | 98133-5732
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Country | US
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Telephone | 571-232-3130
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ML20008810
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License Number State | WA
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