Provider Demographics
NPI:1467249672
Name:BERRY, WARREN CHARLES
Entity type:Individual
Prefix:MR
First Name:WARREN
Middle Name:CHARLES
Last Name:BERRY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12617 SE 54TH ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-5625
Mailing Address - Country:US
Mailing Address - Phone:580-768-4733
Mailing Address - Fax:
Practice Address - Street 1:12617 SE 54TH ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-5625
Practice Address - Country:US
Practice Address - Phone:580-768-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist