Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 78113 | NM |
NPI | 1174570410 |
---|---|
Provider Name | William Berman JR. |
First Address | Sunrise, FL 33323-2843 |
Second Address | Albuquerque, NM 87106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 02/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2128692 | (05) | NM |
D43049 | (02) |