| Doctor Name: | MARK BERGER |
| NPI Number: | 1023471000 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | NP1691A |
| Business Practice Address: | 2327 Sw 4th Ave Ontario, OR - 979141851 |
| Business Phone Number: | 5418892340 |
| Business Fax Number: | 5418892593 |
| Mailing Address: | 2327 Sw 4th Ave, ONTARIO |
| State: | OR |
| Postal Code: | 979141851 |
| Phone Number: | 5418892340 |
| Fax Number: | 5418892593 |
| NPI Enumeration Date: | 03/29/2016 |
| NPI Last Update Date: | 03/29/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SF0001X |
| License Number: | NP1691A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Family Health |
| Taxonomy Definition: | |