1093722746 NPI number — DR. FRANKLIN MORRIS BERRY SR. PH D

Table of content: DR. FRANKLIN MORRIS BERRY SR. PH D (NPI 1093722746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093722746 NPI number — DR. FRANKLIN MORRIS BERRY SR. PH D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRY
Provider First Name:
FRANKLIN
Provider Middle Name:
MORRIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
PH D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093722746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7585 E REDFIELD RD
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-6938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-310-9028
Provider Business Mailing Address Fax Number:
602-354-6938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7585 E REDFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-6938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-310-9028
Provider Business Practice Location Address Fax Number:
602-354-4402
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1313 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 043468 . This is a "MANAGED HEALTH NETWORK AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0608270 . This is a "BLUE CROSS BS OF AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 162131 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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