Provider Demographics
NPI:1013964261
Name:MIEREZ BERNARD, MARCIA CHARMIN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:CHARMIN
Last Name:MIEREZ BERNARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CREEK BED CIRCLE NW
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-6348
Mailing Address - Country:US
Mailing Address - Phone:305-509-2841
Mailing Address - Fax:
Practice Address - Street 1:202 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1218
Practice Address - Country:US
Practice Address - Phone:256-974-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S 9130207Q00000X
ALDO1296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2697131-00Medicaid
AL1013964261OtherNPI
AL142883Medicaid
AL142883Medicaid