Provider Demographics
NPI:1295074680
Name:BERKELEY, EDWARD WINSTON (MD FRCS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WINSTON
Last Name:BERKELEY
Suffix:
Gender:M
Credentials:MD FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8344 SW MAPLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6430
Mailing Address - Country:US
Mailing Address - Phone:503-297-7555
Mailing Address - Fax:
Practice Address - Street 1:8344 SW MAPLERIDGE DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6430
Practice Address - Country:US
Practice Address - Phone:503-297-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10431174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist