Organization
BERRY MEDICAL CARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE GRAHAM (CREDENTIALING SPECIALIST)
(972) 245-1315
Entity
Organization
Contact information
Practice address
4201 E BERRY ST, STE 15, FORT WORTH, TX 76105-5053
(817) 535-8200
(817) 535-8207
Mailing address
4201 E BERRY ST, STE 15, FORT WORTH, TX 76105-5053
(817) 535-8200
(817) 535-8207
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
03/12/2015
Last updated
03/12/2015
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