Provider Demographics
NPI:1417933698
Name:BERRIEN, STEPHEN BROPHY (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BROPHY
Last Name:BERRIEN
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 1:1524 MCHENRY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4500
Mailing Address - Country:US
Mailing Address - Phone:209-527-0615
Mailing Address - Fax:209-527-5201
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-527-0615
Practice Address - Fax:209-527-5201
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00C321460207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC321460Medicaid
CAOOC321460Medicaid