MEDICARE: MILLARD TODD BERRY M.D.

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	6338A	WY

General Provider Information

NPI Number	:	1790891919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILLARD TODD BERRY M.D.

Provider Business Mailing Address
First Line	:	625 ALBANY AVE
Second Line	:
City	:	TORRINGTON
State	:	WY
Zip	:	82240-1530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 ALBANY AVE
Second Line	:
City	:	TORRINGTON
State	:	WY
Zip	:	82240-1530
Country	:	US
Telephone Number	:	307-532-2107
Fax Number	:

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/09/2025

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