MEDICARE: BRIAN J BERRY MD

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
1	208000000X	Pediatrics Physician	MD00024170	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	370013712	OTHER	WA	RAILROAD
2	8930009	OTHER	WA	STATE CRIME VICTIMS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0129626	OTHER	WA	STATE L&I
5	8939534	OTHER	WA	STATE CRIME VICTIMS
6	0205806	OTHER	WA	STATE L&I
7	0192336	OTHER	WA	STATE L&I
8	8940788	OTHER	WA	STATE CRIME VICTIMS

General Provider Information

NPI Number	:	1295744555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN J BERRY MD

Provider Business Mailing Address
First Line	:	7210 40TH ST W
Second Line	:	STE 100
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4318
Country	:	US
Telephone Number	:	253-564-0170
Fax Number	:	253-207-4240

Provider Business Practice Location Address
First Line	:	7210 40TH ST W
Second Line	:	STE 100
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4318
Country	:	US
Telephone Number	:	253-564-0170
Fax Number	:	253-207-4240

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	11/16/2010

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Directions to “ BRIAN J BERRY MD” Practice Location

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