Provider Demographics
NPI:1639439573
Name:BERKVENS, BENNIE JOHANNES (MD)
Entity Type:Individual
Prefix:
First Name:BENNIE
Middle Name:JOHANNES
Last Name:BERKVENS
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 1:5930 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2413
Mailing Address - Country:US
Mailing Address - Phone:254-592-3253
Mailing Address - Fax:
Practice Address - Street 1:917 S PORT AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2301
Practice Address - Country:US
Practice Address - Phone:361-882-6161
Practice Address - Fax:888-711-1008
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ0607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program