Provider Demographics
NPI:1740378694
Name:BERKLEY, VINCENT ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANTHONY
Last Name:BERKLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:198 S. SKILL CENTER ROAD
Mailing Address - City:SACATON
Mailing Address - State:AZ
Mailing Address - Zip Code:85147
Mailing Address - Country:US
Mailing Address - Phone:520-562-4208
Mailing Address - Fax:520-562-3415
Practice Address - Street 1:198 S. SKILL CENTER ROAD
Practice Address - Street 2:
Practice Address - City:SACATON
Practice Address - State:AZ
Practice Address - Zip Code:85147
Practice Address - Country:US
Practice Address - Phone:520-562-4208
Practice Address - Fax:602-263-1619
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2776207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0713620OtherBCBS
AZ406977Medicaid
AZ030078Medicare Oscar/Certification
AZH42101Medicare UPIN
AZAZ0713620OtherBCBS
AZH45101Medicare PIN
AZ406977Medicaid