Berg, Jack L.

Berg, Jack L. is an individual health care provider with primary practice located at 7813 Youree Dr , Shreveport LA 71105-5505. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Berg, Jack L. can be contacted via phone (318) 212-3830.

Contact Information

Primary practice address
7813 Youree Dr Shreveport LA 71105-5505
Phone: (318) 212-3830
Fax: (318) 212-3835
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 15000R Louisiana

Profile Details

NPI number 1639160021
LBN Legal business name Berg, Jack L.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 3rd, 2005
Last updated Jun 17th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639160021 NPPES
Louisiana MEDICAID 1160571

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