Individual
DONALD EVONS BERLYN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1200 W ROUTE 66, FLAGSTAFF, AZ 86001-6238
(928) 556-0776
(928) 213-5470
Mailing address
1200 W ROUTE 66, FLAGSTAFF, AZ 86001-6238
(928) 556-0776
(928) 213-5470
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
AZPT1463
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19031463
STATE FUND
AZ
01
—
AZ0293060
BCBS
AZ
Enumeration date
08/09/2005
Last updated
07/08/2007
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