MEDICARE: SPENCER D BERRY MD

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	207Q00000X	Family Medicine Physician	7514	ND

General Provider Information

NPI Number	:	1215954219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER D BERRY MD

Provider Business Mailing Address
First Line	:	3175 SIENNA DR S
Second Line	:	103
City	:	FARGO
State	:	ND
Zip	:	58104-8910
Country	:	US
Telephone Number	:	701-205-3088
Fax Number	:	701-335-7808

Provider Business Practice Location Address
First Line	:	3175 SIENNA DR S
Second Line	:	103
City	:	FARGO
State	:	ND
Zip	:	58104-8910
Country	:	US
Telephone Number	:	701-205-3088
Fax Number	:	701-335-7808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	03/14/2012

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Directions to “ SPENCER D BERRY MD” Practice Location

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