Provider Demographics
NPI:1043244098
Name:PERRRY, SAMUEL H II (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:H
Last Name:PERRRY
Suffix:II
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 1:410 SEAGULL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-8910
Mailing Address - Country:US
Mailing Address - Phone:308-534-9230
Mailing Address - Fax:308-534-5016
Practice Address - Street 1:210 MCNEEL LN
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6290
Practice Address - Country:US
Practice Address - Phone:308-534-9230
Practice Address - Fax:308-534-5016
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12525208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068774800Medicaid
NE47068774800Medicaid