Provider Demographics
NPI:1962404475
Name:BERNARD, THOMAS JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JEFFREY
Last Name:BERNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9425 HEALTHPLEX DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8148
Mailing Address - Country:US
Mailing Address - Phone:318-683-5171
Mailing Address - Fax:318-683-5182
Practice Address - Street 1:9425 HEALTHPLEX DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8148
Practice Address - Country:US
Practice Address - Phone:318-683-5171
Practice Address - Fax:318-683-5182
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAL022545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1493716Medicaid
LAG61864Medicare UPIN
LA1493716Medicaid