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Glenn Ira Bernstein

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NPI Number Detailed Information

Provider Information:

Name: Glenn Ira Bernstein
Gender: M
Provider License Number If Given: MD160464

NPI Information:

NPI: 1366441925
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 7/18/2005

Last Update Date: 9/2/2015

Provider Business Mailing Address:

Address: PO BOX 278
Woodburn, OR 97071
Phone Number: 9719835333
Fax Number: 9719835326

Provider Business Practice Location Address:

Address: 406 WELCH ST
Silverton, OR 97381
Phone Number: 5038738853
Fax Number: 5038738355

Provider Taxonomy:

Primary: 207V00000X
Secondary (if any): 207V00000X
State: OR

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