Provider Demographics
NPI:1184184285
Name:BERNARD, RODDY JANIEL (MD)
Entity type:Individual
Prefix:
First Name:RODDY
Middle Name:JANIEL
Last Name:BERNARD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 N MCMULLEN BOOTH RD STE 303
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2022
Mailing Address - Country:US
Mailing Address - Phone:727-725-6110
Mailing Address - Fax:727-669-9742
Practice Address - Street 1:61 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:TREASURE ISLAND
Practice Address - State:FL
Practice Address - Zip Code:33706-3113
Practice Address - Country:US
Practice Address - Phone:727-853-1701
Practice Address - Fax:727-825-1354
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD480505207R00000X
FLME166273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine