Provider Demographics
NPI:1639163611
Name:BERNARD, L. BARRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:L.
Middle Name:BARRETT
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 1:6110 REGAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-3322
Mailing Address - Country:US
Mailing Address - Phone:502-254-1845
Mailing Address - Fax:
Practice Address - Street 1:1 KINGS DAUGHTERS DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3300
Practice Address - Country:US
Practice Address - Phone:812-265-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19830207R00000X, 208M00000X
IN01042384A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100386220Medicaid
IN232320IMedicare PIN
C78391Medicare UPIN