Basic Information
| Provider Information | |||||||||
| NPI: | 1639439573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERKVENS | ||||||||
| FirstName: | BENNIE | ||||||||
| MiddleName: | JOHANNES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5930 REGENCY DR | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784142413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2545923253 | ||||||||
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| Practice Location | |||||||||
| Address1: | 917 S PORT AVE | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784052301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618826161 | ||||||||
| FaxNumber: | 8887111008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2012 | ||||||||
| LastUpdateDate: | 07/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | Q0607 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.