Healthcare Provider Details

I. General information

NPI: 1891791653
Provider Name (Legal Business Name): ROBERT J. BERENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 E ERICKSON DR
TUCSON AZ
85712-2826
US

IV. Provider business mailing address

PO BOX 31235
TUCSON AZ
85751-1235
US

V. Phone/Fax

Practice location:
  • Phone: 520-299-8200
  • Fax: 520-299-8202
Mailing address:
  • Phone: 520-324-4780
  • Fax: 520-324-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number17979
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: