Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 79-9 | NM |
NPI | 1003985706 |
---|---|
Provider Name | Dr. Burton M Berkson |
First Address | Las Cruces, NM 88011-8257 |
Second Address | Las Cruces, NM 88011-8257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 01/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D43045 | (02) | NM |