Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | IL | |
Y | 207KA0200X | Allergist | R1G07 | MO |
NPI | 1295849594 |
---|---|
Provider Name | Douglas R Berson |
First Address | Chesterfield, MO 63017-3451 |
Second Address | Chesterfield, MO 63017-3451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0200049 | UNITED HEALTHCARE (01) | |
048551 | HEALTH ALLIANCE (01) | IL |
1124116001 | CIGNA HEALTHCARE (01) | |
241220 | HEALTHLINK (01) | |
24698 | HEALTHCARE USA (01) | |
24742 | BLUE CROSS BLUE SHIELD (01) | |
8635 | GROUP HEALTH PLAN (01) | |
E43835 | (02) | MO |