Healthcare Provider Details

I. General information

NPI: 1003955675
Provider Name (Legal Business Name): MR. PHILLIP C BERG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 TANNER WILLIAMS RD
MOBILE AL
36608-8322
US

IV. Provider business mailing address

8501 TANNER WILLIAMS RD
MOBILE AL
36608-8322
US

V. Phone/Fax

Practice location:
  • Phone: 251-441-6725
  • Fax:
Mailing address:
  • Phone: 251-441-6725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: