Healthcare Provider Details

I. General information

NPI: 1871568816
Provider Name (Legal Business Name): WAYNE E. BERRYHILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 06/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 W ROCK CREEK RD SUITE 110
NORMAN OK
73072-2202
US

IV. Provider business mailing address

3033 NW 63RD ST SUITE 152
OKLAHOMA CITY OK
73116-3634
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-2666
  • Fax: 405-364-9627
Mailing address:
  • Phone: 405-755-6651
  • Fax: 405-755-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number23401
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: