Provider Demographics
NPI:1487644423
Name:BERRY, ALISON J (MD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:J
Last Name:BERRY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:8042 WURZBACH RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3818
Mailing Address - Country:US
Mailing Address - Phone:210-614-8100
Mailing Address - Fax:210-568-0311
Practice Address - Street 1:12602 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 207
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3269
Practice Address - Country:US
Practice Address - Phone:210-490-8941
Practice Address - Fax:210-545-5616
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-07-11
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Provider Licenses
StateLicense IDTaxonomies
TXF3757207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122056805Medicaid
B05174Medicare UPIN
TX8B7973Medicare ID - Type Unspecified