Individual
BRADLEY R. BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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