Provider Demographics
NPI:1366460081
Name:BERNETT, JORGE R (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:R
Last Name:BERNETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:365 LENNON LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5910
Mailing Address - Country:US
Mailing Address - Phone:925-947-2334
Mailing Address - Fax:925-947-5889
Practice Address - Street 1:365 LENNON LN
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5910
Practice Address - Country:US
Practice Address - Phone:925-947-2334
Practice Address - Fax:925-947-5889
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG70835207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G708350Medicaid
CA00G708350Medicaid
CAG48589Medicare UPIN