Basic Information
| Provider Information | |||||||||
| NPI: | 1316924806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERNICKER | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6445 MAIN STREET | ||||||||
| Address2: | OPC 24 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134419948 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6445 MAIN STREET | ||||||||
| Address2: | OPC 24 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134419948 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 03/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | H9796 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 88Z530 | 01 | TX | BLUE CROSS BLUE SHIELD OF TEXAS | OTHER | 132473309 | 05 | TX | MEDICAID | 132473302 | 05 | TX | MEDICAID | 132473307 | 05 | TX | MEDICAID |