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General NPI Number Information
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NPI Number | 1962423970
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Entity Type | Individual
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Provider Name | ALFRED GLEN BERWICK MD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 508 MEDICAL CENTER BLVD SUITE 200
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City | CONROE
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State | TX
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Zip | 77304-2808
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Country | US
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Telephone | 936-760-4600
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Fax | 936-760-4601
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Provider Business Mailing Address
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Address Line | 508 MEDICAL CENTER BLVD SUITE 200
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City | CONROE
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State | TX
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Zip | 77304-2808
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Country | US
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Telephone | 936-760-4600
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Fax | 936-760-4601
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E6039
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License Number State | TX
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