Basic Information
| Provider Information | |||||||||
| NPI: | 1073556403 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHN | ||||||||
| FirstName: | BERCHMANS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9724379605 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 W MAYFIELD RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760142083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174676092 | ||||||||
| FaxNumber: | 8174650680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 06/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | F5589 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 138883708 | 05 | TX | MEDICAID | 138883709 | 05 | TX | MEDICAID | 138883702 | 05 | TX | MEDICAID | 138883701 | 05 | TX | MEDICAID | 138883706 | 05 | TX | MEDICAID | 138883707 | 05 | TX | MEDICAID | 8R1476 | 01 | TX | BLUE CROSS OF TX | OTHER | 138883704 | 05 | TX | MEDICAID | 138883710 | 05 | TX | MEDICAID | 138883703 | 05 | TX | MEDICAID | 138883705 | 05 | TX | MEDICAID |