Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | DRP 0000604 | CO |
Y | 207X00000X | Orthopaedic Surgeon | F3042 | TX |
NPI | 1013971134 |
---|---|
Provider Name | Michael Edward Berkeley |
First Address | Houston, TX 77019-3908 |
Second Address | Houston, TX 77019-3908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 26/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1244409 | (05) | CO |
D24450 | (02) |