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General NPI Number Information
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NPI Number | 1730570037
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Entity Type | Organization
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Legal Business Name | RICHARD W. BERRY M.D.
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 631 W 38TH ST STE 3
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City | AUSTIN
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State | TX
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Zip | 78705-1251
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Country | US
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Telephone | 512-459-1238
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Fax | 512-459-3557
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Provider Business Mailing Address
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Address Line | 631 W 38TH ST STE 3
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City | AUSTIN
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State | TX
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Zip | 78705-1251
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Country | US
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Telephone | 512-459-1238
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Fax | 512-459-3557
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. COLIN BERRY
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Credential |
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Telephone | 512-459-1238
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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 | E0814
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License Number State | TX
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