Provider Demographics
NPI:1619017043
Name:BERGER, ALISA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:MARIE
Last Name:BERGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ABNER JACKSON PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5157
Mailing Address - Country:US
Mailing Address - Phone:979-297-4140
Mailing Address - Fax:979-297-4919
Practice Address - Street 1:115 ABNER JACKSON PKWY STE C
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5157
Practice Address - Country:US
Practice Address - Phone:979-297-4140
Practice Address - Fax:979-297-4919
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5052208800000X
WI82525208800000X
IAMD-46471208800000X
IN01084523A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192360901Medicaid
TX8F7119Medicare PIN