Provider Demographics
NPI:1316029937
Name:BERSHOF, JOHN FOX (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FOX
Last Name:BERSHOF
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 1:4500 E 9TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3900
Mailing Address - Country:US
Mailing Address - Phone:303-399-7662
Mailing Address - Fax:303-399-1314
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3900
Practice Address - Country:US
Practice Address - Phone:303-399-7662
Practice Address - Fax:303-399-1314
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26056174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28323OtherBCBS
CO240005333OtherRAILROAD MEDICARE
CO240005333OtherRAILROAD MEDICARE
COCG8728Medicare PIN