Provider Demographics
NPI:1477565729
Name:BERG, ERIC CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CHRISTIAN
Last Name:BERG
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 1:906 W MCDERMOTT DR
Mailing Address - Street 2:#116-371
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6510
Mailing Address - Country:US
Mailing Address - Phone:972-658-8184
Mailing Address - Fax:972-727-6229
Practice Address - Street 1:906 W MCDERMOTT DR
Practice Address - Street 2:#116-371
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6510
Practice Address - Country:US
Practice Address - Phone:972-747-5840
Practice Address - Fax:972-747-5841
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8912207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG08849Medicare UPIN
8018B7Medicare ID - Type Unspecified