MEDICARE: DR. BRUCE JEREMY BERNIE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	35.038152	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194720987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE JEREMY BERNIE M.D.

Provider Business Mailing Address
First Line	:	9000 N MAIN ST
Second Line	:	SUITE 234
City	:	DAYTON
State	:	OH
Zip	:	45415-1180
Country	:	US
Telephone Number	:	937-277-8988
Fax Number	:	937-832-2421

Provider Business Practice Location Address
First Line	:	9000 N MAIN ST
Second Line	:	SUITE 234
City	:	DAYTON
State	:	OH
Zip	:	45415-1180
Country	:	US
Telephone Number	:	937-277-8988
Fax Number	:	937-832-2421

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	09/07/2011

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