Provider Demographics
NPI:1306814470
Name:BERNARD, DOUGLAS D (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:D
Last Name:BERNARD
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 1:350 7TH ST N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5754
Mailing Address - Country:US
Mailing Address - Phone:239-513-7144
Mailing Address - Fax:
Practice Address - Street 1:800 GOODLETTE ROAD N
Practice Address - Street 2:SUITE 310
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102
Practice Address - Country:US
Practice Address - Phone:239-624-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-2379207Q00000X
FLME145975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140986001Medicaid
2652096OtherUHC
AR03010012800OtherQUALCHOICE
P00323450OtherRAILROAD MEDICARE
AR5L530Medicare PIN
P00323450OtherRAILROAD MEDICARE