Provider Demographics
NPI:1003886748
Name:BERKHEIMER, BRUCE KEVIN (DPM)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:KEVIN
Last Name:BERKHEIMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4702
Mailing Address - Country:US
Mailing Address - Phone:501-279-7716
Mailing Address - Fax:501-279-7195
Practice Address - Street 1:1700 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4702
Practice Address - Country:US
Practice Address - Phone:501-279-7716
Practice Address - Fax:501-279-7195
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR143213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S766Medicare PIN