Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 111N00000X | AZ |
NPI | 1760657704 |
---|---|
Provider Name | Thomas Bernard Berndt |
First Address | Scottsdale, AZ 85271-3124 |
Second Address | Scottsdale, AZ 85257-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |