Provider Demographics
NPI:1629014683
Name:BERNAL, JAIME E (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:E
Last Name:BERNAL
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 1:801 E NOLANA
Mailing Address - Street 2:STE 11
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6112
Mailing Address - Country:US
Mailing Address - Phone:956-630-4669
Mailing Address - Fax:956-668-7139
Practice Address - Street 1:801 E NOLANA
Practice Address - Street 2:STE 11
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6112
Practice Address - Country:US
Practice Address - Phone:956-630-4669
Practice Address - Fax:956-668-7139
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3096208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0859DFOtherBCBS OF TX
TXK3096OtherLICENSE #
G04053Medicare UPIN