Provider Demographics
NPI:1366547770
Name:PERRON, BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:PERRON
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 1:4025 SOUTH PADRE ISLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4420
Mailing Address - Country:US
Mailing Address - Phone:361-855-4472
Mailing Address - Fax:361-852-0212
Practice Address - Street 1:4025 SOUTH PADRE ISLAND DRIVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4420
Practice Address - Country:US
Practice Address - Phone:361-855-4472
Practice Address - Fax:361-852-0212
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9909207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000JR383Medicaid
B25464Medicare UPIN
TXJR38Medicare ID - Type Unspecified