MEDICARE: DR. JOHN NATHAN BERRY M.D.

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	2085B0100X	Body Imaging Physician	N1551	TX
2	2085R0202X	Diagnostic Radiology Physician	N1551	TX

General Provider Information

NPI Number	:	1982685848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN NATHAN BERRY M.D.

Provider Business Mailing Address
First Line	:	1207 CHISOLM TRL
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-9462
Country	:	US
Telephone Number	:	210-262-4993
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 CHISOLM TRL
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-9462
Country	:	US
Telephone Number	:	210-262-4993
Fax Number	:

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	04/15/2022

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