Provider Demographics
NPI:1306880364
Name:BERNREUTER, JON C (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:C
Last Name:BERNREUTER
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 1:1 W LAKESHORE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7271
Mailing Address - Country:US
Mailing Address - Phone:205-823-7248
Mailing Address - Fax:
Practice Address - Street 1:1 W LAKESHORE DR STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-7271
Practice Address - Country:US
Practice Address - Phone:205-930-2950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009984445Medicaid
AL10293I5979 280Medicare PIN
C69946Medicare UPIN
AL102I935978 LSMedicare PIN