Provider Demographics
NPI:1477574044
Name:BERNARD, JAMES D (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:BERNARD
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7176
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:3 PINE CONE DR
Practice Address - Street 2:UNIT 102
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8685
Practice Address - Country:US
Practice Address - Phone:386-864-6005
Practice Address - Fax:386-864-6110
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-06-16
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Provider Licenses
StateLicense IDTaxonomies
FLOS3277207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271909600Medicaid
FL01015AMedicare PIN
FL271909600Medicaid