Provider Demographics
NPI:1538434733
Name:BERNAUER, ROBERT DALE JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DALE
Last Name:BERNAUER
Suffix:JR
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 1:2825 COUNTRY CLUB RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5915
Mailing Address - Country:US
Mailing Address - Phone:337-444-5867
Mailing Address - Fax:
Practice Address - Street 1:4345 NELSON RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-480-7900
Practice Address - Fax:337-480-7901
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAGETP.200984207P00000X
LAMD207933208600000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2198998Medicaid