Provider Demographics
NPI:1831202241
Name:POWERS, BERNARD J (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:J
Last Name:POWERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BERNARD
Other - Middle Name:J
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10103 RIDGEGATE PKWY
Mailing Address - Street 2:STE 312
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5520
Mailing Address - Country:US
Mailing Address - Phone:303-788-8888
Mailing Address - Fax:303-790-2567
Practice Address - Street 1:10103 RIDGEGATE PKWY
Practice Address - Street 2:STE 312
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5520
Practice Address - Country:US
Practice Address - Phone:303-788-8888
Practice Address - Fax:303-790-2567
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28046207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01280460Medicaid
CO01280460Medicaid
COP00145170Medicare PIN