Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 28128 | NC |
Y | 208600000X | Surgeon | 28128 | NC |
NPI | 1003857772 |
---|---|
Provider Name | Dr. John Berry JR. |
First Address | Kinston, NC 28503 |
Second Address | Kinston, NC 28501-1589 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 29/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8915186 | (05) | NC |
C82809 | (02) |