Healthcare Provider Details

I. General information

NPI: 1992740237
Provider Name (Legal Business Name): BRIAN BERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 HILYARD ST
EUGENE OR
97401-3718
US

IV. Provider business mailing address

PO BOX 4078
PORTLAND OR
97208-4078
US

V. Phone/Fax

Practice location:
  • Phone: 503-686-7300
  • Fax:
Mailing address:
  • Phone: 888-633-0086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD20468
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierA49789
Identifier TypeOTHER
Identifier State
Identifier IssuerGROUP HEALTH
# 2
IdentifierA49789
Identifier TypeOTHER
Identifier State
Identifier IssuerLIPA
# 3
IdentifierXPY190701
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer
# 4
Identifier8279978
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 5
IdentifierA49789
Identifier TypeOTHER
Identifier State
Identifier IssuerPROVIDENCE
# 6
IdentifierA027
Identifier TypeOTHER
Identifier State
Identifier IssuerCHAMPS
# 7
Identifier168935
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: