Individual
JACK BERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2428 SANTA MONICA BLVD, SANTA MONICA, CA 90404-2045
(310) 315-1000
Mailing address
1516 COTNER AVE, LOS ANGELES, CA 90025-3303
(310) 445-2951
(310) 479-1459
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
C33328
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C333280
BLUE SHIELD
CA
05
—
00C333280
—
CA
Enumeration date
07/20/2006
Last updated
08/08/2022
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