Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 2023 | IA |
NPI | 1629116629 |
---|---|
Provider Name | Dr. David Timothy Berg |
First Address | Johnston, IA 50131-2751 |
Second Address | Des Moines, IA 50310-5753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2007 |
Last Update Date | 08/07/2007 |