Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | R5B53 | MO |
N | 207PE0004X | Emergency Medical Services | MOR5B53 | MO |
N | 207PE0004X | Emergency Medical Services | R5B53 | MO |
NPI | 1134212764 |
---|---|
Provider Name | Dr. Terry L. Berry |
First Address | Osage Beach, MO 65065-3050 |
Second Address | Osage Beach, MO 65065-3050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 01/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134212764 | (05) | MO |
A13895 | (02) | MO |