Provider Demographics
NPI:1114080173
Name:BERNAL, CARLOS V (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:V
Last Name:BERNAL
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:PO BOX 57845
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7845
Mailing Address - Country:US
Mailing Address - Phone:281-724-1862
Mailing Address - Fax:281-724-1859
Practice Address - Street 1:905 W MEDICAL CENTER BLVD STE 402
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4009
Practice Address - Country:US
Practice Address - Phone:281-724-1862
Practice Address - Fax:281-724-1859
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21223Medicare UPIN