Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | DI38592 | FL |
NPI | 1043403231 |
---|---|
Provider Name | Dr. Sue Ann Berend |
First Address | Fort Worth, TX 76131-3223 |
Second Address | Fort Worth, TX 76131-3223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 03/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BERES1 | DEPT. OF HEALTH (01) | NY |
DI38592 | DEPT. OF HEALTH (01) | FL |
DRM42 | DEPT. OF HEALTH SERVICES (01) | CA |