Provider Demographics
NPI:1316924806
Name:BERNICKER, ERIC H (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:H
Last Name:BERNICKER
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 800022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0022
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:2030 MOUNTAIN VIEW AVE STE 540
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3183
Practice Address - Country:US
Practice Address - Phone:720-494-7110
Practice Address - Fax:720-494-7111
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9796207RX0202X
CODR.0070375207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132473307Medicaid
TX132473302Medicaid
TX132473309Medicaid
TX88Z530OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX132473307Medicaid
TX900001440Medicare PIN
TX264020YMVQMedicare PIN