Provider Demographics
NPI:1578524930
Name:BERRY, JOHN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2800 PEOPLES ST STE 80
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4158
Mailing Address - Country:US
Mailing Address - Phone:423-631-0101
Mailing Address - Fax:423-328-9027
Practice Address - Street 1:2800 PEOPLES ST STE 80
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-631-0101
Practice Address - Fax:423-328-9027
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41124207RC0000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ051445Medicaid
FL261791900Medicaid
FL261791900Medicaid