Provider Demographics
NPI:1003820465
Name:BERNARD, JOHN V (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:V
Last Name:BERNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-3640
Mailing Address - Fax:208-625-3645
Practice Address - Street 1:526 WATER STREET
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:NJ
Practice Address - Zip Code:07823
Practice Address - Country:US
Practice Address - Phone:908-475-4600
Practice Address - Fax:908-475-4590
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM15080207Q00000X
NJMA53978207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3417506Medicaid
PA001966249004OtherMEDICAID
PA050857OtherMEDICARE
NJ3417506Medicaid
E23199Medicare UPIN