MEDICARE: DR. RICHARD ALAN BERG MD

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	2085R0202X	Diagnostic Radiology Physician	G-53552	CA

General Provider Information

NPI Number	:	1619963386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ALAN BERG MD

Provider Business Mailing Address
First Line	:	5882 BIRKDALE LN
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-8906
Country	:	US
Telephone Number	:	805-784-0195
Fax Number	:	805-784-0297

Provider Business Practice Location Address
First Line	:	5882 BIRKDALE LN
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-8906
Country	:	US
Telephone Number	:	805-784-0195
Fax Number	:	805-784-0297

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	07/08/2007

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