Provider Demographics
NPI:1740270891
Name:BERRY, PAUL S (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:216 I ST
Mailing Address - Street 2:A-165
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-2301
Mailing Address - Country:US
Mailing Address - Phone:510-541-8784
Mailing Address - Fax:209-892-9102
Practice Address - Street 1:1108 WARD AVE
Practice Address - Street 2:STE A
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8529
Practice Address - Country:US
Practice Address - Phone:510-541-8784
Practice Address - Fax:209-892-9102
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG72073208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72073OtherSTAE LICENSE PHYSICIAN
CA00G720730OtherMEDI-CAL
CA00G720730OtherMEDI-CAL
CAE98813Medicare UPIN