Healthcare Provider Details

I. General information

NPI: 1871738831
Provider Name (Legal Business Name): PAUL ANTHONY BERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E DOVE AVE STE 400
MCALLEN TX
78504-4684
US

IV. Provider business mailing address

PO BOX 749
PHARR TX
78577-1614
US

V. Phone/Fax

Practice location:
  • Phone: 956-362-8160
  • Fax: 956-362-8169
Mailing address:
  • Phone: 956-362-8160
  • Fax: 956-362-8169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberN1552
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME169780
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberN1552
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberN1552
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberN1552
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: