Provider Demographics
NPI:1144256850
Name:BERG, ALAN G (DO)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:G
Last Name:BERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 432
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-2444
Mailing Address - Country:US
Mailing Address - Phone:214-333-3033
Mailing Address - Fax:214-330-2163
Practice Address - Street 1:1050 N WESTMORELAND RD
Practice Address - Street 2:SUITE 432
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2444
Practice Address - Country:US
Practice Address - Phone:214-333-3033
Practice Address - Fax:214-330-2163
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041891502Medicaid
TX8F7793Medicare PIN
TX041891502Medicaid
TX8B6102Medicare ID - Type Unspecified