Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 31095 | OK |
N | 208600000X | Surgeon | 31095 | OK |
N | 208200000X | Surgeon | N6172 | TX |
N | 208600000X | Surgeon | N6172 | TX |
Y | 2086S0105X | Surgery of the Hand | 31095 | OK |
N | 2086S0105X | Surgery of the Hand | N6172 | TX |
NPI | 1649589227 |
---|---|
Provider Name | Ms. Carolyn M Berg |
First Address | Tulsa, OK 74137-4265 |
Second Address | Tulsa, OK 74137-4265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2010 |
Last Update Date | 09/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200573930A | (05) | OK |