Provider Demographics
NPI:1699738229
Name:BERG, CHRISTOPHER J (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:BERG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 W POST RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2417
Mailing Address - Country:US
Mailing Address - Phone:702-430-5333
Mailing Address - Fax:
Practice Address - Street 1:2350 MIRACLE MILE # 600A
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7505
Practice Address - Country:US
Practice Address - Phone:928-758-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA00739363A00000X
AZ8338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1047012OtherNCCPA
NVCQ142ZMedicare PIN