Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | P0957 | TX |
NPI | 1245283803 |
---|---|
Provider Name | Matthew Berchuck |
First Address | Dallas, TX 75246-2029 |
Second Address | Dallas, TX 75246-2029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 25/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009934598 | (05) | AL |
009941273 | (05) | AL |
051531430 | BLUE CROSS OF ALABAMA (01) | AL |
051531832 | BLUE CROSS OF ALABAMA (01) | AL |
3125627-02 | (05) | TX |
E63955 | (02) | AL |