Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | K8005 | TX |
NPI | 1114964426 |
---|---|
Provider Name | Mrs. Marcy L Berry |
First Address | Plano, TX 75023-4189 |
Second Address | Plano, TX 75023-4189 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 08/07/2007 |