Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 31902 | AZ |
N | 207PE0004X | Emergency Medical Services | 31902 | AZ |
NPI | 1184670317 |
---|---|
Provider Name | Dr. Gregory Berman |
First Address | Scottsdale, AZ 85260-6622 |
Second Address | Chandler, AZ 85224-5605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 21/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
855356-01 | (05) | AZ |
AZ0736120 | BC/BS (01) | AZ |
I10875 | (02) | AZ |