MEDICARE: FRANK W BERRY JR MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	C39601	CA

General Provider Information

NPI Number	:	1194040758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANK W BERRY JR MD INC

Provider Business Mailing Address
First Line	:	3178 COLLINS DR
Second Line	:	SUITE B
City	:	MERCED
State	:	CA
Zip	:	95348-3155
Country	:	US
Telephone Number	:	209-383-6484
Fax Number	:	209-383-5315

Provider Business Practice Location Address
First Line	:	3178 COLLINS DR
Second Line	:	SUITE B
City	:	MERCED
State	:	CA
Zip	:	95348-3155
Country	:	US
Telephone Number	:	209-383-6484
Fax Number	:	209-383-5315

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRANK WELDON BERRY JR.
Credential	:	M.D.
Telephone Number	:	209-383-6484

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/07/2010

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