Provider Demographics
NPI:1447224415
Name:BERSON, DANIEL G (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:BERSON
Suffix:
Gender:M
Credentials:DO
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 300087
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-0002
Mailing Address - Country:US
Mailing Address - Phone:512-407-8444
Mailing Address - Fax:512-407-8097
Practice Address - Street 1:2304 HANCOCK DR STE 4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2540
Practice Address - Country:US
Practice Address - Phone:512-407-8444
Practice Address - Fax:512-407-8097
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-2246-19207L00000X
TXL-9100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL-9100OtherSTATE LICENSE
P00302021OtherMEDICARE RAILROAD
P00376055OtherMEDICARE RAILROAD
TX1666901103Medicaid
TX166690102Medicaid
8G3095Medicare PIN
P00376055OtherMEDICARE RAILROAD
8D6488Medicare PIN