Provider Demographics
NPI:1902842412
Name:BERDEJA, JESUS G (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:G
Last Name:BERDEJA
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:PO BOX 440100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0100
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:
Practice Address - Street 1:250 25TH AVE N
Practice Address - Street 2:STE 412
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1632
Practice Address - Country:US
Practice Address - Phone:615-986-7000
Practice Address - Fax:615-986-7601
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43220207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A601430Medicaid
TN4172891OtherBCBS OF TN
TN3001257Medicaid
G65263Medicare UPIN
TN4172891OtherBCBS OF TN