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General NPI Number Information
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NPI Number | 1669470704
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Entity Type | Individual
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Provider Name | RICHARD PHILLIP BERRY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 09/28/2012
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Provider Practice Location Address
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Address Line | 905 S MAIN ST
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City | SHATTUCK
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State | OK
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Zip | 73858-9205
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Country | US
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Telephone | 580-938-5275
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Fax | 580-938-2256
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Provider Business Mailing Address
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Address Line | PO BOX 703
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City | SHATTUCK
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State | OK
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Zip | 73858-0703
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Country | US
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Telephone | 580-938-5275
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Fax | 580-938-2256
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18450
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License Number State | OK
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