Provider Demographics
NPI:1972510493
Name:BERNARD, JOHNNY R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:R
Last Name:BERNARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:159 ISLAND ESTATES PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-2206
Mailing Address - Country:US
Mailing Address - Phone:901-301-1942
Mailing Address - Fax:
Practice Address - Street 1:6029 OLD KINGS RD
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137
Practice Address - Country:US
Practice Address - Phone:901-301-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350990442085R0001X
FLME963662085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology