Provider Demographics
NPI:1891804613
Name:BERNICK, JAMES JAY (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JAY
Last Name:BERNICK
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 1:2717 W BAKER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-2204
Mailing Address - Country:US
Mailing Address - Phone:281-427-6730
Mailing Address - Fax:281-427-0248
Practice Address - Street 1:2717 W BAKER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-2204
Practice Address - Country:US
Practice Address - Phone:281-427-6730
Practice Address - Fax:281-427-0248
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8324207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035778201Medicaid
00RU36Medicare ID - Type Unspecified
TX035778201Medicaid