Provider Demographics
NPI:1699885541
Name:DAVID L. BERRY, M.D. PA
Entity type:Organization
Organization Name:DAVID L. BERRY, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:NUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-206-0101
Mailing Address - Street 1:6500 N MOPAC
Mailing Address - Street 2:BUILDING 1, SUITE 1205
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3282
Mailing Address - Country:US
Mailing Address - Phone:512-206-0101
Mailing Address - Fax:512-206-0212
Practice Address - Street 1:6500 N MOPAC
Practice Address - Street 2:BUILDING 1, SUITE 1205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3282
Practice Address - Country:US
Practice Address - Phone:512-206-0101
Practice Address - Fax:512-206-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1499207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081281001Medicaid
TXF36655Medicare UPIN
TX081281001Medicaid