| Organization Name: | BERRY MEDICAL CARE, PLLC |
| NPI Number: | 1659764850 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELE GRAHAM (CREDENTIALING SPECIALIST) |
| Mailing Address: | 4201 E Berry St Ste 15 Fort Worth |
| State: | TX US |
| Postal Code: | 761055053 |
| Phone Number: | 8175358200 |
| Fax Number: | 8175358207 |
| NPI Enumeration Date: | 03/12/2015 |
| NPI Last Update Date: | 03/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |