Healthcare Provider Details

I. General information

NPI: 1912962903
Provider Name (Legal Business Name): RICHARD B BERKLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S LINCOLN AVE
STEAMBOAT SPRINGS CO
80487-8907
US

IV. Provider business mailing address

715 HORIZON DR STE 225
GRAND JUNCTION CO
81506-8743
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-2141
  • Fax: 970-879-7912
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number38649
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: