=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770775272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN FOX BERSHOF MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2007
-----------------------------------------------------
Last Update Date | 11/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4500 E 9TH AVE 100
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80220-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-399-7662
-----------------------------------------------------
Fax | 303-399-1314
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4500 E 9TH AVE SUITE 100
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80220-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-399-7662
-----------------------------------------------------
Fax | 303-399-1314
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN FOX BERSHOF
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 303-399-7662
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 26056
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------