MEDICARE: WILLIAM L 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	207P00000X	Emergency Medicine Physician	C-4913	AR
2	207Q00000X	Family Medicine Physician	C-4913	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50447	OTHER	AR	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841227071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM L BERRY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 639
Second Line	:
City	:	DANVILLE
State	:	AR
Zip	:	72833-0639
Country	:	US
Telephone Number	:	479-495-2241
Fax Number	:	479-495-6290

Provider Business Practice Location Address
First Line	:	719 DETROIT STREET
Second Line	:
City	:	DANVILLE
State	:	AR
Zip	:	72833-0639
Country	:	US
Telephone Number	:	479-495-2241
Fax Number	:	479-495-6290

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	09/14/2021

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Directions to “ WILLIAM L BERRY M.D.” Practice Location

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