Provider Demographics
NPI:1184602948
Name:BERRY, JOHN B (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5667 SHADY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-1014
Mailing Address - Country:US
Mailing Address - Phone:713-796-2101
Mailing Address - Fax:713-796-1827
Practice Address - Street 1:4635 SOUTHWEST FWY STE 230
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7104
Practice Address - Country:US
Practice Address - Phone:713-796-2101
Practice Address - Fax:713-796-1827
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5915207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1102455101Medicaid
TXC13425Medicare UPIN
TX110245101Medicaid
C13425Medicare UPIN