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General NPI Number Information
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NPI Number | 1639276587
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Entity Type | Individual
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Provider Name | BERNARD R CANLAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 6337 61ST ST W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98467-4935
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Country | US
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Telephone | 904-608-1369
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Fax | 904-268-0409
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Provider Business Mailing Address
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Address Line | PO BOX 64112
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98464-0112
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Country | US
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Telephone | 904-608-1369
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Fax | 904-268-0409
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME84394
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License Number State | FL
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