Healthcare Provider Details

I. General information

NPI: 1619960259
Provider Name (Legal Business Name): JOHN D BERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 PLEASANT ST STE 150
DES MOINES IA
50309
US

IV. Provider business mailing address

7147 VISTA DR STE 150
WEST DES MOINES IA
50266-9313
US

V. Phone/Fax

Practice location:
  • Phone: 515-244-5109
  • Fax: 515-241-3505
Mailing address:
  • Phone: 515-875-9925
  • Fax: 515-875-9923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMD-29631
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-29631
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: