Provider Demographics
NPI:1265628531
Name:ROBERT P BERMAN, MD
Entity Type:Organization
Organization Name:ROBERT P BERMAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-331-9241
Mailing Address - Street 1:400 MEDIC LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-5567
Mailing Address - Country:US
Mailing Address - Phone:281-331-9241
Mailing Address - Fax:281-331-2745
Practice Address - Street 1:400 MEDIC LN
Practice Address - Street 2:SUITE A
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5567
Practice Address - Country:US
Practice Address - Phone:281-331-9241
Practice Address - Fax:281-331-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00LH18Medicare PIN