Provider Demographics
NPI:1972589117
Name:BERGHAUSEN, EDWARD J (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:BERGHAUSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:630 N ALVERNON WAY
Mailing Address - Street 2:SUITE 351
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1843
Mailing Address - Country:US
Mailing Address - Phone:520-881-2600
Mailing Address - Fax:520-881-2844
Practice Address - Street 1:630 N ALVERNON WAY
Practice Address - Street 2:SUITE 351
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1843
Practice Address - Country:US
Practice Address - Phone:520-881-2600
Practice Address - Fax:520-881-2844
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2016-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ30321207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery