Provider Demographics
NPI:1649257312
Name:BERGER, BRIAN B (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:B
Last Name:BERGER
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 1:3705 MEDICAL PARKWAY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1023
Mailing Address - Country:US
Mailing Address - Phone:512-454-5851
Mailing Address - Fax:512-454-5853
Practice Address - Street 1:9707 ANDERSON MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2302
Practice Address - Country:US
Practice Address - Phone:512-279-1251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0354207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1331738-10Medicaid
TX133173809Medicaid
TXTXB137233Medicare PIN
TXTXB137230Medicare PIN
TX1331738-10Medicaid