Provider Demographics
NPI:1831155787
Name:BERHE, MEZGEBE (MD)
Entity type:Individual
Prefix:DR
First Name:MEZGEBE
Middle Name:
Last Name:BERHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 WORTH ST
Mailing Address - Street 2:710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2029
Mailing Address - Country:US
Mailing Address - Phone:214-823-2533
Mailing Address - Fax:214-824-8679
Practice Address - Street 1:3409 WORTH ST
Practice Address - Street 2:710
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2029
Practice Address - Country:US
Practice Address - Phone:214-823-2533
Practice Address - Fax:214-824-8679
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1510174400000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177738501Medicaid
TX1143000OtherAETNA
TXM1510OtherSTATE LICENSE
TX8J3801OtherBLUE CROSS BLUE SHIELD
TXMD1510OtherWORKERS COMP
TX8D9498Medicare ID - Type Unspecified
TX8J3801OtherBLUE CROSS BLUE SHIELD