Healthcare Provider Details

I. General information

NPI: 1518929819
Provider Name (Legal Business Name): LOUIS ALOJZ BEREC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1083 E RELHAM DR LOXLEY FAMILY MEDICAL CENTER
LOXLEY AL
36551
US

IV. Provider business mailing address

PO BOX 2048
MOBILE AL
36652-2048
US

V. Phone/Fax

Practice location:
  • Phone: 251-964-4011
  • Fax: 251-964-4012
Mailing address:
  • Phone: 251-432-4117
  • Fax: 251-964-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22526
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: