Provider Demographics
NPI:1386900835
Name:BERRY, ADAM KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:KENNETH
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12953 PALMS WEST DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4991
Mailing Address - Country:US
Mailing Address - Phone:561-793-1713
Mailing Address - Fax:888-217-9051
Practice Address - Street 1:12953 PALMS WEST DR STE 102
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4991
Practice Address - Country:US
Practice Address - Phone:561-793-1713
Practice Address - Fax:888-217-9051
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2024-12-19
Deactivation Date:2024-11-19
Deactivation Code:
Reactivation Date:2024-12-05
Provider Licenses
StateLicense IDTaxonomies
FLME121310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine