MEDICARE: DARRAH BERCK M.D.

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	207V00000X	Obstetrics & Gynecology Physician	2020023402	MO
2	207V00000X	Obstetrics & Gynecology Physician	94-08988	KS

General Provider Information

NPI Number	:	1831548254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRAH BERCK M.D.

Provider Business Mailing Address
First Line	:	1601 E BROADWAY STE 100
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-5821
Country	:	US
Telephone Number	:	573-443-8796
Fax Number	:	573-499-0373

Provider Business Practice Location Address
First Line	:	1601 E BROADWAY STE 100
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-5821
Country	:	US
Telephone Number	:	573-443-8796
Fax Number	:	573-499-0373

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

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	03/17/2021

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