Provider Demographics
NPI:1497829584
Name:BERRIOS, LUIS D (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:D
Last Name:BERRIOS
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 1:425 CROSS ST
Mailing Address - Street 2:UNIT 311 & 312
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-4877
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 CROSS ST
Practice Address - Street 2:UNIT 311 & 312
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4877
Practice Address - Country:US
Practice Address - Phone:941-625-1275
Practice Address - Fax:941-625-1286
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79576OtherBCBS
FL204281084OtherTAX ID
FL204281084OtherTAX ID
FL79576OtherBCBS