Provider Demographics
NPI:1457411613
Name:BERRY, BARBARA A (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:BERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:ALLGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7600 N 15TH ST
Mailing Address - Street 2:#190
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4327
Mailing Address - Country:US
Mailing Address - Phone:602-200-3800
Mailing Address - Fax:602-200-3838
Practice Address - Street 1:7600 N 15TH ST
Practice Address - Street 2:#190
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4348
Practice Address - Country:US
Practice Address - Phone:602-200-3800
Practice Address - Fax:602-200-3838
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ255655Medicaid
AZ255655Medicaid
AZWDBYK02Medicare ID - Type Unspecified