Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G42167 | CA |
N | 208200000X | Surgeon | G42167 | CA |
N | 208600000X | Surgeon | G42167 | CA |
NPI | 1508914748 |
---|---|
Provider Name | Mark Howard Berman |
First Address | Santa Monica, CA 90401-2108 |
Second Address | Santa Monica, CA 90401-2108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
48844 | (02) | CA |