Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | MD-29631 | IA |
NPI | 1619960259 |
---|---|
Provider Name | Dr. John D Berger |
First Address | West Des Moines, IA 50266-9313 |
Second Address | Des Moines, IA 50309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 21/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1619960259 | (05) | IA |
F67586 | (02) | IA |