Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | L5634 | TX |
N | 111NI0900X | Internist | L5634 | TX |
Y | 207RI0200X | Infectious Disease | L5634 | TX |
NPI | 1053407080 |
---|---|
Provider Name | Steven Lee Berk |
First Address | Lubbock, TX 79408-5865 |
Second Address | Lubbock, TX 79430-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 11/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00075046 | NM MEDICAID (01) | |
047380302 | (05) | TN |
047380302 | (05) | TX |
100018050A | OKLAHOMA MEDICAID (01) | TX |
108501101 | FIRSTCARE (01) | TX |
108501102 | (05) | TX |
8M1179 | HMO BLUE (01) | TX |
BE08F0561 | BC BS (01) | TX |