Provider Demographics
NPI:1972317733
Name:BERNARD, MOSES LEE (MA-PC (CPT))
Entity type:Individual
Prefix:
First Name:MOSES
Middle Name:LEE
Last Name:BERNARD
Suffix:
Gender:
Credentials:MA-PC (CPT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 MADISON ST STE 810
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1357
Mailing Address - Country:US
Mailing Address - Phone:808-465-0342
Mailing Address - Fax:
Practice Address - Street 1:1229 MADISON ST STE 810
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1357
Practice Address - Country:US
Practice Address - Phone:808-465-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPC61650789246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy