Provider Demographics
NPI:1114080173
Name:BERNAL, CARLOS V (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:V
Last Name:BERNAL
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:PO BOX 1325
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-1325
Mailing Address - Country:US
Mailing Address - Phone:903-927-6140
Mailing Address - Fax:903-927-6117
Practice Address - Street 1:805 LINDSEY DR
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5271
Practice Address - Country:US
Practice Address - Phone:903-927-6140
Practice Address - Fax:903-927-6117
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21223Medicare UPIN