Healthcare Provider Details

I. General information

NPI: 1245631100
Provider Name (Legal Business Name): JAMES BERRY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE STE 306
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12TH AVE STE 306
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6946
  • Fax: 305-243-3377
Mailing address:
  • Phone: 305-243-6946
  • Fax: 305-243-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number05-37558
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberOS19762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: