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General NPI Number Information
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NPI Number | 1912111006
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Entity Type | Organization
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Legal Business Name | EDWARD W. BERRY MD PC
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 4403 HARRISON BLVD STE 3680
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City | OGDEN
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State | UT
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Zip | 84403-3289
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Country | US
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Telephone | 801-387-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 1652 WILDCAT LN # 1
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City | OGDEN
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State | UT
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Zip | 84403-3236
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Country | US
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Telephone | 801-393-2249
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Fax | 801-393-9909
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD W BERRY
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Credential | M.D.
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Telephone | 801-387-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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