Healthcare Provider Details

I. General information

NPI: 1114964426
Provider Name (Legal Business Name): MARCY L BERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 W SPRING CREEK PKWY SUITE 300
PLANO TX
75023-4189
US

IV. Provider business mailing address

2109 W SPRING CREEK PKWY SUITE 300
PLANO TX
75023-4189
US

V. Phone/Fax

Practice location:
  • Phone: 972-208-8668
  • Fax: 972-208-3186
Mailing address:
  • Phone: 972-208-8668
  • Fax: 972-208-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberK8005
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: