Provider Demographics
NPI:1548351364
Name:BERMEN, JOHN F JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:BERMEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3465 S PIONEER PARKWAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2013
Mailing Address - Country:US
Mailing Address - Phone:801-967-0282
Mailing Address - Fax:801-967-0565
Practice Address - Street 1:3465 S 4155 WEST
Practice Address - Street 2:SUITE 5
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2013
Practice Address - Country:US
Practice Address - Phone:801-967-0282
Practice Address - Fax:801-967-0565
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT1597111205207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
19010400OtherOWCP
D07301Medicare UPIN