Provider Demographics
NPI:1730139247
Name:BERNARD, ESTRADA J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTRADA
Middle Name:J
Last Name:BERNARD
Suffix:JR
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 1:3831 PIPER ST
Mailing Address - Street 2:SUITE S450
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4672
Mailing Address - Country:US
Mailing Address - Phone:907-258-6999
Mailing Address - Fax:907-258-9470
Practice Address - Street 1:3831 PIPER ST
Practice Address - Street 2:SUITE S450
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4672
Practice Address - Country:US
Practice Address - Phone:907-258-6999
Practice Address - Fax:907-258-9470
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3221207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD32211Medicaid
AKMD32211Medicaid
AKF07342Medicare UPIN