Provider Demographics
NPI:1114942307
Name:BERNARD, DOUGLAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:BERNARD
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 1:510 JEFFERSON TERRACE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4948
Mailing Address - Country:US
Mailing Address - Phone:337-365-8161
Mailing Address - Fax:337-365-0294
Practice Address - Street 1:510 JEFFERSON TERRACE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4948
Practice Address - Country:US
Practice Address - Phone:337-365-8161
Practice Address - Fax:337-365-0294
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05302R207X00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1311197Medicaid
LAB61355Medicare UPIN
LA1311197Medicaid
LA0326560001Medicare NSC