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NPI Code Detail

MEDICARE: MR. MATTHEW JOSEPH BERRIA PA

MEDICARE: MR. MATTHEW JOSEPH BERRIA PA
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
1363A00000XPhysician AssistantPA00573OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11040302OTHERPACIFIC SOURCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982791810
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW JOSEPH BERRIA PA
Provider Business Mailing Address
First Line : 1100 NW 12TH ST
Second Line :
City : FRUITLAND
State : ID
Zip : 83619-5040
Country : US
Telephone Number : 208-452-6556
Fax Number : 541-216-6557
Provider Business Practice Location Address
First Line : 1100 NW 12TH ST
Second Line :
City : FRUITLAND
State : ID
Zip : 83619-5040
Country : US
Telephone Number : 208-452-6556
Fax Number : 541-216-6557
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 08/16/2023

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Directions to “ MR. MATTHEW JOSEPH BERRIA PA” Practice Location

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