Provider Demographics
NPI:1417976994
Name:BERNARD, REBEKAH (MD)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 CAROLINA WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17595 S TAMIAMI TRL
Practice Address - Street 2:SUITE 227
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4570
Practice Address - Country:US
Practice Address - Phone:239-322-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264407000Medicaid
FLH64831Medicare UPIN
FL13645YMedicare PIN