Healthcare Provider Details

I. General information

NPI: 1831282938
Provider Name (Legal Business Name): DIRK L BERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1649 MCFARLAND BLVD N SUITE 203
TUSCALOOSA AL
35406-2281
US

IV. Provider business mailing address

1649 MCFARLAND BLVD N SUITE 203
TUSCALOOSA AL
35406-2281
US

V. Phone/Fax

Practice location:
  • Phone: 205-556-5541
  • Fax: 205-554-7937
Mailing address:
  • Phone: 205-556-5541
  • Fax: 205-554-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number000016499
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: