Provider Demographics
NPI:1902130701
Name:BERRY, DON WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:WAYNE
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 1:624 RIO GRAND LOOP
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633
Mailing Address - Country:US
Mailing Address - Phone:806-789-6136
Mailing Address - Fax:
Practice Address - Street 1:624 RIO GRAND LOOP
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633
Practice Address - Country:US
Practice Address - Phone:806-789-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4602208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00CB758Medicaid
TXC13422Medicare UPIN
TXCB75Medicare PIN