Provider Demographics
NPI:1336283498
Name:BERNER, KEITH MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MARTIN
Last Name:BERNER
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 1:112 W CENTER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-6073
Mailing Address - Country:US
Mailing Address - Phone:479-935-3076
Mailing Address - Fax:833-259-4137
Practice Address - Street 1:112 W CENTER ST STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-935-3076
Practice Address - Fax:833-259-4137
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-71512084P0800X, 2084P0802X
ARE-70512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AM02Medicare PIN