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General NPI Number Information
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NPI Number | 1053492785
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Entity Type | Organization
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Legal Business Name | DONALD D BERG MD PC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 1005 PENNSYLVANIA AVE SUITE 212
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City | OTTUMWA
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State | IA
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Zip | 52501-6413
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Country | US
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Telephone | 641-682-5443
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Fax | 641-682-6859
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Provider Business Mailing Address
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Address Line | 1005 PENNSYLVANIA AVE SUITE 212
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City | OTTUMWA
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State | IA
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Zip | 52501-6413
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Country | US
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Telephone | 641-682-5443
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Fax | 641-682-6859
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD D BERG
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Credential | MD
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Telephone | 641-682-5443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 18416
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License Number State | IA
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