Provider Demographics
NPI:1407824576
Name:BERNAICHE, MAURICE R (DO)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:R
Last Name:BERNAICHE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 OVEN PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7958
Mailing Address - Country:US
Mailing Address - Phone:850-765-8623
Mailing Address - Fax:
Practice Address - Street 1:500 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6646
Practice Address - Country:US
Practice Address - Phone:850-765-8623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA545472081S0010X, 208VP0014X
FLOS20454208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000032786OtherBMC
MAJ29800OtherBCBS MA
MAAA53780OtherHARVARD PILGRIM
MA7421780OtherAETNA
MA8900941OtherCIGNA
MA226816OtherCONNECTICARE
MA478927OtherTUFTS
MA37645OtherHEALTH NEW ENGLAND
MA478927OtherTUFTS
MAAA53780OtherHARVARD PILGRIM
MA04-2629461OtherNORTHEAST HEALTHCARE ALLI
MA04-2629461OtherPHCS
MA04-2629461OtherUNICARE/GIC
TN142672Medicare UPIN
MA000000032786OtherBMC
MA8900941OtherCIGNA