Provider Demographics
NPI:1871535823
Name:BERRYMAN, ROBERT BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRIAN
Last Name:BERRYMAN
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-370-1513
Practice Address - Fax:214-370-1585
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8458207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043749302Medicaid
TX29851025Medicaid
TX8R1394OtherBLUE CROSS OF TEXAS
TX043749304Medicaid
OK100161590AMedicaid
TX043749303Medicaid
TX043749305Medicaid
TX043749306Medicaid
TX8D1397Medicare PIN
TX8D1398Medicare PIN
TX043749306Medicaid
OK100161590AMedicaid
TX043749302Medicaid
TX8545B9Medicare PIN
TX900003512Medicare PIN