Individual
JEFFREY G BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1111 N LEE AVE, STE 236, OKLAHOMA CITY, OK 73103-2600
(405) 524-4105
Mailing address
PO BOX 5366, EDMOND, OK 73083-5366
(660) 826-5960
(660) 826-4852
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
19893
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100047890A
—
OK
01
—
P00643961
RR MEDICARE
OK
Enumeration date
12/02/2005
Last updated
10/06/2009
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