Provider Demographics
NPI:1194040758
Name:FRANK W BERRY JR MD INC
Entity Type:Organization
Organization Name:FRANK W BERRY JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WELDON
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:209-383-6484
Mailing Address - Street 1:3178 COLLINS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3155
Mailing Address - Country:US
Mailing Address - Phone:209-383-6484
Mailing Address - Fax:209-383-5315
Practice Address - Street 1:3178 COLLINS DR
Practice Address - Street 2:SUITE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3155
Practice Address - Country:US
Practice Address - Phone:209-383-6484
Practice Address - Fax:209-383-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39601207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC396010Medicare PIN
CAA37178Medicare UPIN