Provider Demographics
NPI:1306822499
Name:ROBERT G BERRY JR MD
Entity Type:Organization
Organization Name:ROBERT G BERRY JR MD
Other - Org Name:ORTHOPEDIC REHABILITATION SPECIALISTS OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GEORGETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-448-9456
Mailing Address - Street 1:6630 S MCCARRAN BLVD STE A3
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6184
Mailing Address - Country:US
Mailing Address - Phone:775-828-2863
Mailing Address - Fax:665-710-0568
Practice Address - Street 1:6630 S MCCARRAN BLVD
Practice Address - Street 2:A-4 SIERRA REGIONAL SPINE INSTITUTE
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6136
Practice Address - Country:US
Practice Address - Phone:775-828-2873
Practice Address - Fax:775-828-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV31527Medicare ID - Type Unspecified