Individual provider · Type 1 NPI

Derek Berta

Physician Assistant · Idaho Falls, ID

NPI number 1114572716 Active

Practice location

2860 Channing Way Ste 220
Idaho Falls, ID 83404-7541

Fax (208) 800-6158

Mailing address

PO Box 277381
Atlanta, GA 30384-7381

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000X3371894 (ID)

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1114572716

Derek Berta's National Provider Identifier is 1114572716, issued on Aug 9, 2019. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Idaho Falls, ID. The record was last updated on Mar 17, 2026.