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NPI Code Detail

MEDICARE: ROBERT G BERRY JR MD PC

MEDICARE: ROBERT G BERRY JR MD PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1255340824
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT G BERRY JR MD PC
Provider Business Mailing Address
First Line : 6630 SOUTH MCCARRAN BLVD
Second Line : SUITE A-4
City : RENO
State : NV
Zip : 89509-6135
Country : US
Telephone Number : 775-828-2873
Fax Number : 775-828-2889
Provider Business Practice Location Address
First Line : 2200 SOUTH RANCHO DRIVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0000
Country : US
Telephone Number : 702-677-3607
Fax Number : 702-515-6657
Authorized Official
Title or Position : OWNER OF COMPANY
Name : DR. ROBERT G BERRY JR.
Credential : MD
Telephone Number : 775-828-2873
Provider Enumeration Date : 08/05/2006
Last Update Date : 04/11/2011

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