Individual
GRANT WILSON BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2100 W SUNSET DR, RIVERTON, WY 82501-2274
(307) 857-3445
Mailing address
PO BOX 1810, LANDER, WY 82520-1810
(307) 206-4172
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
10598A
WY
207P00000X
Emergency Medicine Physician
MD043197
DC
207P00000X
Emergency Medicine Physician
R5511
TX
Other
Enumeration date
05/11/2011
Last updated
02/20/2023
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