Individual
PHILLIP RAY BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1145 S UTICA AVE, SUITE 453, TULSA, OK 74104-4000
(918) 596-7078
Mailing address
7514 S 107TH EAST AVE, TULSA, OK 74133-2530
(918) 252-0038
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
3021
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1203021
DHS PRESCRIBER NUMBER
OK
Enumeration date
08/19/2006
Last updated
07/08/2007
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