Provider Demographics
NPI:1285897108
Name:BERNARD, ROBERT L (PA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:BERNARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE
Mailing Address - State:OK
Mailing Address - Zip Code:73547-9334
Mailing Address - Country:US
Mailing Address - Phone:580-535-4670
Mailing Address - Fax:
Practice Address - Street 1:1700 E 1ST STREET
Practice Address - Street 2:
Practice Address - City:GRANITE
Practice Address - State:OK
Practice Address - Zip Code:73547
Practice Address - Country:US
Practice Address - Phone:580-480-3715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK482363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical