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NPI Code Detail

MEDICARE: DR. CRAIG TOBIAS BERENT M.D.

MEDICARE: DR. CRAIG TOBIAS BERENT 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
1207R00000XInternal Medicine PhysicianK3988TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18A3811OTHERTXBLUE CROSS PIN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699824193
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRAIG TOBIAS BERENT M.D.
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-2111
Fax Number :
Provider Business Practice Location Address
First Line : 2608 BROCKTON DR
Second Line :
City : AUSTIN
State : TX
Zip : 78758-4414
Country : US
Telephone Number : 512-654-4050
Fax Number : 512-654-4051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 01/17/2022

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