Provider Demographics
NPI:1215196696
Name:BERSON, DEANE SHORE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANE
Middle Name:SHORE
Last Name:BERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEANE
Other - Middle Name:SHORE
Other - Last Name:COHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1424 NORTH HANCOCK AVENUE 3 WEST
Mailing Address - Street 2:DEANE SHORE BERSON MD
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:719-475-9363
Mailing Address - Fax:
Practice Address - Street 1:1424 NORTH HANCOCK AVENUE 3 WEST
Practice Address - Street 2:DEANE SHORE BERSON MD
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-475-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO195952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry