Provider Demographics
NPI:1144402959
Name:BERNARD, JOHN MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:BERNARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 POST OAK BLVD. UNIT 59
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056
Mailing Address - Country:US
Mailing Address - Phone:917-968-8461
Mailing Address - Fax:
Practice Address - Street 1:1309 W. FAIRMONT PKWAY
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:TX
Practice Address - Zip Code:77056
Practice Address - Country:US
Practice Address - Phone:281-470-0543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012309363A00000X
TXPA07802363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant