Provider Demographics
NPI:1851589386
Name:BERRY, WILLIAM DAN (LSA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DAN
Last Name:BERRY
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3540
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:713-457-5188
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3560
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00383246ZC0007X, 246ZS0410X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85NN28OtherBCBS - XCITE SURGICAL
TX8PX956OtherUS MSO
TXSA00383OtherTEXAS MEDICAL BOARD
TXB3NN63OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS, INC.
TX8LH926OtherBCBS - BLUE STAR SURGICAL ASSISTANTS LLC
TX83NN62OtherBCBS - UNIVERSAL SURGICAL PARTNERS, INC.