Provider Demographics
NPI:1457368730
Name:BERKLEY, WILLIAM GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GREGORY
Last Name:BERKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5625 EIGER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8982
Mailing Address - Country:US
Mailing Address - Phone:512-892-7076
Mailing Address - Fax:512-899-8460
Practice Address - Street 1:5625 EIGER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8982
Practice Address - Country:US
Practice Address - Phone:512-892-7076
Practice Address - Fax:512-899-8460
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAGA034540207R00000X
TXN7524207R00000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX506404YLCDMedicare PIN
E88380Medicare UPIN
GA202I115149Medicare PIN
GA20211I3823Medicare PIN
GA003146454BMedicaid