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General NPI Number Information
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NPI Number | 1639319387
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Entity Type | Individual
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Provider Name | DAVID EDWARD BEREDA D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 1034 S BRENTWOOD BLVD STE 530
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City | RICHMOND HEIGHTS
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State | MO
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Zip | 63117-1271
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Country | US
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Telephone | 314-834-6707
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 N GREEN MOUNT RD
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City | O FALLON
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State | IL
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Zip | 62269-2083
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Country | US
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Telephone | 618-624-5510
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036149289
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 828
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2022045941
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License Number State | MO
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