Provider Demographics
NPI:1073745733
Name:BERNER, MITCHELL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ALAN
Last Name:BERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 E CAMELBACK RD STE 700
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-2400
Mailing Address - Country:US
Mailing Address - Phone:480-478-8400
Mailing Address - Fax:480-306-6949
Practice Address - Street 1:155 N SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2303
Practice Address - Country:US
Practice Address - Phone:323-433-7800
Practice Address - Fax:323-433-7801
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1204512085R0202X
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program