Provider Demographics
NPI:1336193812
Name:BERVEN, SIGURD HARALD (MD)
Entity Type:Individual
Prefix:DR
First Name:SIGURD
Middle Name:HARALD
Last Name:BERVEN
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 1:500 PARNASSUS AVE.
Mailing Address - Street 2:BOX 0728 ROOM MU 320W
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0728
Mailing Address - Country:US
Mailing Address - Phone:415-514-1519
Mailing Address - Fax:415-476-1304
Practice Address - Street 1:400 PARNASSUS AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-353-2739
Practice Address - Fax:415-353-2248
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85133207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G851330Medicaid
CA00G851330Medicaid
CAG93374Medicare UPIN