Individual
MARY JEAN BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1100 CARSON AVE, LA JUNTA, CO 81050-2751
(800) 893-9698
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
17415
CO
Other
Enumeration date
02/13/2007
Last updated
07/08/2007
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