Basic Information
| Provider Information | |||||||||
| NPI: | 1811004435 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERMAN | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3709 N CAMPBELL AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857191563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208383540 | ||||||||
| FaxNumber: | 5203253526 | ||||||||
| Practice Location | |||||||||
| Address1: | 1815 W ST MARYS RD | ||||||||
| Address2: | |||||||||
| City: | TUSCON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857452653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206281400 | ||||||||
| FaxNumber: | 5206284863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 20643 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 164731 | 05 | AZ | MEDICAID | 000617077 | 01 | HUMANA | OTHER | 102550 | 01 | RR MC PIN | OTHER | 102550 | 01 | AZ | RR MC PIN | OTHER | 164731 | 01 | AHCCCS | OTHER | 102551 | 01 | MC COCHISE | OTHER | 102551 | 01 | AZ | RR MC PIN | OTHER | AZ081990 | 01 | AZ BCBS | OTHER | P00806843 | 01 | AZ | RR MEDICARE | OTHER | 102542 | 01 | AZ | RR MC GRP | OTHER | 005502968 | 01 | AZ HEALTH PLAN | OTHER | 102550 | 01 | MC PIMA | OTHER | DD0329 | 01 | TRAVELERS MC | OTHER | 102542 | 01 | RR MC GRP | OTHER | 1147063 | 01 | FIRST HEALTH | OTHER | 1254715 | 01 | CIGNA | OTHER | 164731 | 01 | INDIAN HEALTH | OTHER | 4643399 | 01 | AETNA | OTHER |