Provider Demographics
NPI:1942250469
Name:BERRY, ROBERT H (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:BERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6948 E NIGHT GLOW CIR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-7021
Mailing Address - Country:US
Mailing Address - Phone:480-502-6884
Mailing Address - Fax:
Practice Address - Street 1:6948 E NIGHT GLOW CIR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85262-7021
Practice Address - Country:US
Practice Address - Phone:480-502-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO30425207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200163087OtherCDS
MO245176904Medicaid
MO245176904Medicaid
MO0100135948Medicare ID - Type Unspecified
MO245176904Medicaid