Provider Demographics
NPI:1265490841
Name:BARDELAS, JOSE ANTONIO JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ANTONIO
Last Name:BARDELAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 WESTWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4320
Mailing Address - Country:US
Mailing Address - Phone:336-883-1393
Mailing Address - Fax:336-883-7517
Practice Address - Street 1:100 WESTWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4320
Practice Address - Country:US
Practice Address - Phone:336-883-1393
Practice Address - Fax:336-883-7517
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21622208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0200001OtherUNITED HEALTHCARE
NC8913057Medicaid
NC13057OtherBCBS
0200001OtherUNITED HEALTHCARE
NC201832EMedicare ID - Type Unspecified