Healthcare Provider Details

I. General information

NPI: 1003886748
Provider Name (Legal Business Name): BRUCE KEVIN BERKHEIMER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E MOORE AVE
SEARCY AR
72143-4702
US

IV. Provider business mailing address

1700 E MOORE AVE
SEARCY AR
72143-4702
US

V. Phone/Fax

Practice location:
  • Phone: 501-279-7716
  • Fax: 501-279-7195
Mailing address:
  • Phone: 501-279-7716
  • Fax: 501-279-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number143
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: