Basic Information
| Provider Information | |||||||||
| NPI: | 1861657975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERACHA KOVACHEVICH | ||||||||
| FirstName: | MOSHE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOVACEVIC | ||||||||
| OtherFirstName: | MOSA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1919 WOODLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974031887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185025750 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2300 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974051116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416862828 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD28403 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD28403 | OR | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.