Healthcare Provider Details

I. General information

NPI: 1306997135
Provider Name (Legal Business Name): SALLY C BERGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 OGDEN ST STE 460
DENVER CO
80218-3666
US

IV. Provider business mailing address

500 ELDORADO BLVD STE 6250
BROOMFIELD CO
80021-3421
US

V. Phone/Fax

Practice location:
  • Phone: 303-318-2500
  • Fax: 303-318-2575
Mailing address:
  • Phone: 303-272-0768
  • Fax: 303-318-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28321
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: