Provider Demographics
NPI:1841285707
Name:BARD, JEFFREY D (CRNA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:BARD
Suffix:
Gender:M
Credentials:CRNA
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 5045
Mailing Address - Street 2:ATTN: PROV ENROLL, P.F.S.
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-2754
Mailing Address - Fax:605-322-2727
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-2754
Practice Address - Fax:605-322-2727
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR022430367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1539775Medicaid
SD0065246OtherBLUE CROSS OF SD
MN012K8BAOtherMN BLUECROSS BS
MN047523800Medicaid
SD5751563Medicaid
NE46022474348Medicaid
SD5751562Medicaid
IA2539775Medicaid
SDR022430OtherDAKOTACARE
NE46022474348Medicaid
MN012K8BAOtherMN BLUECROSS BS
SDS65246Medicare PIN
SDS8254Medicare PIN