Provider Demographics
NPI:1932133238
Name:BERNARD, JEANNE DUSTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:DUSTIN
Last Name:BERNARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:J.
Other - Middle Name:DUSTIN
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 12338
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93406-2338
Mailing Address - Country:US
Mailing Address - Phone:805-546-9911
Mailing Address - Fax:805-546-9933
Practice Address - Street 1:2074 PARKER ST
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5052
Practice Address - Country:US
Practice Address - Phone:805-546-9911
Practice Address - Fax:805-546-9933
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7046207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
7105726OtherCIGNA PPO
CA020A70460-20OtherBLUE SHIELD PPIN
CA7047172OtherAETNA
1849643OtherFIRST HEALTH NETWORK
P-11204912OtherMULTIPLAN
H27833Medicare UPIN
CA7047172OtherAETNA
7105726OtherCIGNA PPO