Provider Demographics
NPI:1710961958
Name:BERHOW, PERRY (PA)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:BERHOW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4575
Mailing Address - Country:US
Mailing Address - Phone:507-238-8555
Mailing Address - Fax:
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4575
Practice Address - Country:US
Practice Address - Phone:507-238-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8806363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN595810OtherARAZ
MNHP50065OtherHEALTH PARTNERS
MN07Q58BEMedicaid
MN959478Medicaid
MNMH9041001158OtherPPO
MN01-13393OtherMEDICA
MN01Q58BEOtherBCBS/MEDICARE SUPPLEMENT
MN118121Medicaid
MN78816300Medicaid
MN4042OtherAVERA
MNA026OtherCHAMPUS
MN01Q58BEOtherBCBS
MNHP50065OtherHEALTH PARTNERS