Provider Demographics
NPI:1245485424
Name:CURTIS, BERKLEY CALVIN JR (PA)
Entity type:Individual
Prefix:MR
First Name:BERKLEY
Middle Name:CALVIN
Last Name:CURTIS
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8251 W BROWARD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2703
Mailing Address - Country:US
Mailing Address - Phone:544-759-5359
Mailing Address - Fax:954-475-4637
Practice Address - Street 1:8251 W BROWARD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2703
Practice Address - Country:US
Practice Address - Phone:544-759-5359
Practice Address - Fax:954-475-4637
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005534363AM0700X
FLPA9110411363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I973415Medicare PIN