Stuart Holland Berryman, PA-C
Physician Assistant, Medical in Peoria, IL. Individual provider (NPI-1).
NPI number1093774705
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1093774705
- Entity type
- Individual (NPI-1)
- Name
- Stuart Holland Berryman
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 21, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 085-000441 | IL | Yes |
Practice location
4909 N Glen Park Place RdPeoria, IL 61614-4676
Phone 309-674-7546 · Fax 309-282-0500
Mailing address
4909 N Glen Park Place RdPeoria, IL 61614-4676
Phone 309-674-7546
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