Provider Demographics
NPI:1831756105
Name:BERGER, COLBY (DPM)
Entity type:Individual
Prefix:DR
First Name:COLBY
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9850 GENESEE AVE STE 510
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1213
Mailing Address - Country:US
Mailing Address - Phone:858-450-9218
Mailing Address - Fax:858-450-3296
Practice Address - Street 1:9850 GENESEE AVE STE 510
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-450-9218
Practice Address - Fax:858-450-3296
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5836213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery