Provider Demographics
NPI:1184842460
Name:ERIC S. BERENS, MD, PC
Entity type:Organization
Organization Name:ERIC S. BERENS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-296-5500
Mailing Address - Street 1:6565 E CARONDELET DR
Mailing Address - Street 2:STE. 235
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2157
Mailing Address - Country:US
Mailing Address - Phone:520-296-5500
Mailing Address - Fax:520-296-5800
Practice Address - Street 1:6565 E CARONDELET DR
Practice Address - Street 2:STE. 235
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2157
Practice Address - Country:US
Practice Address - Phone:520-296-5500
Practice Address - Fax:520-296-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ73563Medicare PIN
AZZ117898Medicare PIN