Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | J1191 | TX |
N | 207RC0000X | Internist - Cardiovascular Disease | J1191 | TX |
NPI | 1033118278 |
---|---|
Provider Name | Martin R Berk |
First Address | Dallas, TX 75231-7906 |
Second Address | Dallas, TX 75231-7906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 07/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060025455 | RAILROAD (01) | TX |
060031202 | RAILROAD (01) | TX |
118259401 | (05) | TX |
83G906 | MEDICARE PTAN (01) | TX |
85C475 | BCBS (01) | TX |
C78463 | (02) | |
P00044327 | RAILROAD (01) | TX |