Provider Demographics
NPI:1780872184
Name:BERREEN, JOHN P (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:BERREEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2275 NE DOCTORS DR
Mailing Address - Street 2:STE 2
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6324
Mailing Address - Country:US
Mailing Address - Phone:541-693-5050
Mailing Address - Fax:541-693-5051
Practice Address - Street 1:2275 NE DOCTORS DR
Practice Address - Street 2:STE 2
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6324
Practice Address - Country:US
Practice Address - Phone:541-693-5050
Practice Address - Fax:541-693-5051
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2008-11-21
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Provider Licenses
StateLicense IDTaxonomies
ORMD22414207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288210Medicaid
OR288210Medicaid
ORR131886Medicare PIN