Individual
BRADLEY R. BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
425 UNIVERSITY BLVD, ROUND ROCK, TX 78665-1053
(512) 509-0200
(512) 218-6330
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
MD00043078
WA
208000000X
Pediatrics Physician
Primary
N5567
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263645
LABOR & INDUSTRIES
WA
05
—
8371452
—
WA
Enumeration date
09/23/2005
Last updated
12/06/2021
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