Provider Demographics
NPI:1588612741
Name:BERRY, WILLIAM L (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:STE.609 LB120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-826-8201
Mailing Address - Fax:214-827-8515
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:STE.609 LB120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-826-8201
Practice Address - Fax:214-827-8515
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2011-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXD4034207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0810OtherBCBS
TX103789704Medicaid
TX103789704Medicaid