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General NPI Number Information
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NPI Number | 1245283803
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Entity Type | Individual
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Provider Name | MATTHEW BERCHUCK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 3409 WORTH ST 300
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City | DALLAS
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State | TX
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Zip | 75246-2029
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Country | US
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Telephone | 214-865-1350
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Fax | 214-865-1351
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Provider Business Mailing Address
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Address Line | 3409 WORTH ST 300
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City | DALLAS
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State | TX
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Zip | 75246-2029
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Country | US
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Telephone | 214-865-1350
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Fax | 214-865-1351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | P0957
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License Number State | TX
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