Provider Demographics
NPI:1831282938
Name:BERRY, DIRK L (MD)
Entity Type:Individual
Prefix:MR
First Name:DIRK
Middle Name:L
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 MCFARLAND BLVD N
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2281
Mailing Address - Country:US
Mailing Address - Phone:205-556-5541
Mailing Address - Fax:205-554-7937
Practice Address - Street 1:1649 MCFARLAND BLVD N
Practice Address - Street 2:SUITE 203
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2281
Practice Address - Country:US
Practice Address - Phone:205-556-5541
Practice Address - Fax:205-554-7937
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000016499207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000087432Medicaid
AL51087432OtherBLUE CROSS/BLUE SHIELD OF ALABAMA
E73793Medicare UPIN
AL000087432Medicare ID - Type Unspecified