MEDICARE: TRACY A BERG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	MD00032615	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376637421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY A BERG M.D.

Provider Business Mailing Address
First Line	:	16201 E INDIANA AVE
Second Line	:	STE 3100
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-2830
Country	:	US
Telephone Number	:	509-891-8904
Fax Number	:	509-344-3104

Provider Business Practice Location Address
First Line	:	16201 E INDIANA AVE
Second Line	:	STE 3100
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-2830
Country	:	US
Telephone Number	:	509-891-8904
Fax Number	:	509-344-3104

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/02/2016

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Directions to “ TRACY A BERG M.D.” Practice Location

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