Provider Demographics
NPI:1508192055
Name:BERNARD, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:BERNARD
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 1:11070 KATY FWY
Mailing Address - Street 2:#1428
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4709
Mailing Address - Country:US
Mailing Address - Phone:717-903-8900
Mailing Address - Fax:717-798-9891
Practice Address - Street 1:11070 KATY FWY
Practice Address - Street 2:#1428
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-4709
Practice Address - Country:US
Practice Address - Phone:717-903-8900
Practice Address - Fax:717-798-9891
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439441207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA194329Medicare PIN