Organization
BLUEBONNET EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM C JERNBERG MD (PRESIDENT-GENERAL PARTNER)
(214) 712-2000
Entity
Organization
Contact information
Practice address
3201 W STATE HIGHWAY 22, CORSICANA, TX 75110-2450
(903) 654-6821
(214) 712-2487
Mailing address
1717 MAIN ST, SUITE 5200, DALLAS, TX 75201-4612
(214) 712-2000
(214) 712-2487
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0069HW
BCBS
TX
Enumeration date
11/29/2006
Last updated
04/20/2008
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