Provider Demographics
NPI:1649342643
Name:BERG, RION AGAR (DPM)
Entity type:Individual
Prefix:DR
First Name:RION
Middle Name:AGAR
Last Name:BERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 NE 125TH ST
Mailing Address - Street 2:STE 130
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4373
Mailing Address - Country:US
Mailing Address - Phone:206-368-7000
Mailing Address - Fax:206-361-9273
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:STE 130
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-368-7000
Practice Address - Fax:206-361-9273
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000286213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA17323OtherLABOR & INDUSTRIES
WA5180330001OtherDMERC
WA1708908Medicaid
WABE 2113OtherREGENCE BLUE SHIELD
WAP00133667Medicare ID - Type UnspecifiedRAILROAD DR. BERG
WAG8802255Medicare PIN
WA17323OtherLABOR & INDUSTRIES
WA5180330001OtherDMERC
WAG8802253Medicare PIN
WABE 2113OtherREGENCE BLUE SHIELD