Provider Demographics
NPI:1841247913
Name:SHORE, BERNARD L (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:L
Last Name:SHORE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1110 HIGHLANDS PLAZA DR E
Mailing Address - Street 2:STE 375
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1350
Mailing Address - Country:US
Mailing Address - Phone:314-367-3113
Mailing Address - Fax:314-454-9382
Practice Address - Street 1:1110 HIGHLANDS PLAZA DR E
Practice Address - Street 2:STE 375
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1350
Practice Address - Country:US
Practice Address - Phone:314-367-3113
Practice Address - Fax:314-454-9382
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-08-18
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Provider Licenses
StateLicense IDTaxonomies
MOR8656207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
003010056Medicare PIN
A12085Medicare UPIN