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General NPI Number Information
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NPI Number | 1265693121
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Entity Type | Organization
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Legal Business Name | LEONARD BERRY JR LLC
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Dates
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Enumeration Date | 06/23/2008
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 9455 S LANCASTER HUTCHINS RD
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City | HUTCHINS
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State | TX
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Zip | 75141-3368
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Country | US
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Telephone | 972-225-0081
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Fax | 972-225-0805
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Provider Business Mailing Address
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Address Line | PO BOX 860
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City | HUTCHINS
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State | TX
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Zip | 75141-0860
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Country | US
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Telephone | 972-225-0081
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Fax | 972-225-0805
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Authorized Official
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Title or Position | OWNER
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Name | LEONARD AUTWOOD BERRY JR.
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Credential | MD
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Telephone | 972-225-0081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | H3620
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License Number State | TX
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