Provider Demographics
NPI:1225025141
Name:BERNARD, CLEMENT F (MD)
Entity Type:Individual
Prefix:
First Name:CLEMENT
Middle Name:F
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 1:841 UNION ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2610
Mailing Address - Country:US
Mailing Address - Phone:931-685-4886
Mailing Address - Fax:931-685-6997
Practice Address - Street 1:841 UNION ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2610
Practice Address - Country:US
Practice Address - Phone:931-685-4886
Practice Address - Fax:931-685-6997
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29263207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3183777Medicaid
TN3183777Medicare ID - Type Unspecified
TN3183777Medicaid