Healthcare Provider Details

I. General information

NPI: 1821319468
Provider Name (Legal Business Name): CRYSTAL BERRY-ROBERTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRYSTAL BERRY M.D.

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST SUITE 205
AUSTIN TX
78705-1000
US

IV. Provider business mailing address

4515 SETON CENTER PKWY SUITE 215-CREDENTIALING
AUSTIN TX
78759-5785
US

V. Phone/Fax

Practice location:
  • Phone: 512-451-0161
  • Fax: 512-406-7333
Mailing address:
  • Phone: 512-231-5548
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberP9304
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberP9304
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: