Brian J Berry, MD
Individual provider Active NPI Pediatrics Physician · University Place, WA
NPI 1295744555 · NPPES record last updated Nov 16, 2010
Key facts
- NPI
- 1295744555
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- MD00024170 (WA)
- Practice address
- 7210 40TH St W
Ste 100
University Place, WA 98466-4318 - Phone
- (253) 564-0170
- Fax
- (253) 207-4240
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00024170 | WA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fox Medical Center | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD00024170 | WA | Yes |
Addresses
Primary practice location
7210 40TH St W
Ste 100
University Place, WA 98466-4318
Mailing address
7210 40TH St W
Ste 100
University Place, WA 98466-4318
Phone (253) 564-0170
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 370013712 | Other | WA | RAILROAD |
| 8930009 | Other | WA | STATE CRIME VICTIMS |
| 1021823 | Medicaid | WA | |
| 0129626 | Other | WA | STATE L&I |
| 8939534 | Other | WA | STATE CRIME VICTIMS |
| 0205806 | Other | WA | STATE L&I |
| 0192336 | Other | WA | STATE L&I |
| 8940788 | Other | WA | STATE CRIME VICTIMS |
Other providers in University Place, WA
- Tyler Shaquille Beauchamp
- Martine Bedimo-Mbia
- Michaela Jade Beggs
- Beltone Hearing Center
- Keena C Berndt-Morrow
- Denise Rachel Bessette
- Katherine Beth-Juddah
- Kristina Elizabeth Betz
- Beyond Blue Skies LLC
- Tammy D. Bhang
All providers in University Place, WA · Pediatrics Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.