Provider Demographics
NPI:1831391358
Name:BERNER, MATHEW DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:DAVID
Last Name:BERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14436 SE MOUNTAIN RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4041
Mailing Address - Country:US
Mailing Address - Phone:503-658-2912
Mailing Address - Fax:
Practice Address - Street 1:10000 SE MAIN ST STE 45
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2461
Practice Address - Country:US
Practice Address - Phone:503-251-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087692207P00000X, 390200000X
ORMD152470207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM90900050Medicare PIN
MIC96038070Medicare PIN