Provider Demographics
NPI:1639276587
Name:CANLAS, BERNARD R (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:R
Last Name:CANLAS
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:PO BOX 64112
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98464-0112
Mailing Address - Country:US
Mailing Address - Phone:904-608-1369
Mailing Address - Fax:904-268-0409
Practice Address - Street 1:6337 61ST ST W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-4935
Practice Address - Country:US
Practice Address - Phone:904-608-1369
Practice Address - Fax:904-268-0409
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84394207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050091271OtherRAILROAD MEDICARE
FL51489OtherBCBS
FL51489OtherBCBS
FL51489YMedicare ID - Type Unspecified