Provider Demographics
NPI:1639333628
Name:R DALE BERNAUER MD APMC
Entity Type:Organization
Organization Name:R DALE BERNAUER MD APMC
Other - Org Name:BERNAUER CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-474-6960
Mailing Address - Street 1:4150 NELSON RD
Mailing Address - Street 2:BLDG D STE 1
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-474-6960
Mailing Address - Fax:337-474-6970
Practice Address - Street 1:4150 NELSON RD
Practice Address - Street 2:BLDG D STE 1
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-474-6960
Practice Address - Fax:337-474-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04478R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1966789Medicaid
LA1192805Medicaid
LA1966789Medicaid
LA50969Medicare PIN
LA1192805Medicaid
LA5R664Medicare PIN