Provider Demographics
NPI:1073556403
Name:JOHN, BERCHMANS (MD)
Entity Type:Individual
Prefix:DR
First Name:BERCHMANS
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:515 W MAYFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2083
Practice Address - Country:US
Practice Address - Phone:817-467-6092
Practice Address - Fax:817-465-0680
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF55892085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138883708Medicaid
TX138883709Medicaid
TX138883702Medicaid
TX138883701Medicaid
TX138883706Medicaid
TX138883707Medicaid
TX8R1476OtherBLUE CROSS OF TX
TX138883704Medicaid
TX138883710Medicaid
TX138883703Medicaid
TX138883705Medicaid
TX138883708Medicaid
TX8R1476OtherBLUE CROSS OF TX
TX138883707Medicaid
TX87713KMedicare PIN