Provider Demographics
NPI:1003898065
Name:HERBST, BERNARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:M
Last Name:HERBST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 664056
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-4056
Mailing Address - Country:US
Mailing Address - Phone:317-353-9777
Mailing Address - Fax:317-357-6922
Practice Address - Street 1:5839 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6560
Practice Address - Country:US
Practice Address - Phone:317-353-9777
Practice Address - Fax:317-357-6922
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01031995A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN142910AMedicare PIN