Individual
ELYSSA BERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8600
Mailing address
PO BOX 589, FORT DEFIANCE, AZ 86504-0589
(928) 792-8600
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301113504
MI
Other
Enumeration date
06/18/2014
Last updated
05/24/2019
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