Provider Demographics
NPI:1205950623
Name:BERGE, FRED JAY (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:JAY
Last Name:BERGE
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 1:300 N SAN ANTONIO RD
Mailing Address - Street 2:BUILDING 3, SUITE 215
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1316
Mailing Address - Country:US
Mailing Address - Phone:805-681-5220
Mailing Address - Fax:805-681-5262
Practice Address - Street 1:300 N SAN ANTONIO RD
Practice Address - Street 2:BUILDING 3, SUITE 215
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1316
Practice Address - Country:US
Practice Address - Phone:805-681-5220
Practice Address - Fax:805-681-5262
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG839112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H91844Medicare UPIN
00G839110Medicare ID - Type Unspecified