Provider Demographics
NPI:1518042282
Name:BERNER, JON ERIC
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:ERIC
Last Name:BERNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18500 156TH AVE NE
Mailing Address - Street 2:STE 201 JON BERNER MD PHD
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072
Mailing Address - Country:US
Mailing Address - Phone:425-481-0429
Mailing Address - Fax:425-483-0660
Practice Address - Street 1:18500 156TH AVE NE
Practice Address - Street 2:STE 201 JON BERNER MD PHD
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072
Practice Address - Country:US
Practice Address - Phone:425-481-0429
Practice Address - Fax:425-483-0660
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000335772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45659Medicare UPIN