Provider Demographics
NPI:1902816242
Name:DAVID M. BERZON, MD,PA
Entity Type:Organization
Organization Name:DAVID M. BERZON, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-694-1300
Mailing Address - Street 1:1602 ROCK PRAIRIE RD
Mailing Address - Street 2:STE 2100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8306
Mailing Address - Country:US
Mailing Address - Phone:979-694-1300
Mailing Address - Fax:
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:STE 2100
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-694-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00123ZMedicare ID - Type Unspecified