Provider Demographics
NPI:1518090133
Name:JONATHAN B BARD, MD, PA
Entity Type:Organization
Organization Name:JONATHAN B BARD, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-378-8381
Mailing Address - Street 1:7135 MIMOSA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5441
Mailing Address - Country:US
Mailing Address - Phone:214-378-8381
Mailing Address - Fax:214-853-5415
Practice Address - Street 1:710 HUNTERS ROW CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4001
Practice Address - Country:US
Practice Address - Phone:817-453-7444
Practice Address - Fax:817-453-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK79932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00249WMedicare ID - Type Unspecified
TXG67695Medicare UPIN