MEDICARE: DR. DEANE SHORE BERSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	19595	CO

General Provider Information

NPI Number	:	1215196696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEANE SHORE BERSON MD

Provider Business Mailing Address
First Line	:	1424 NORTH HANCOCK AVENUE 3 WEST
Second Line	:	DEANE SHORE BERSON MD
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903
Country	:	US
Telephone Number	:	719-475-9363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1424 NORTH HANCOCK AVENUE 3 WEST
Second Line	:	DEANE SHORE BERSON MD
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903
Country	:	US
Telephone Number	:	719-475-9363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/10/2008

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