Provider Demographics
NPI:1528095312
Name:BERRY, STEVEN L (MD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:L
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:CREDENTIALING DEPARTMENT
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-429-8150
Practice Address - Street 1:173 N 400 W
Practice Address - Street 2:STE C 11
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1909
Practice Address - Country:US
Practice Address - Phone:801-802-7373
Practice Address - Fax:801-802-7733
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
UT343507-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G61948Medicare UPIN