Provider Demographics
NPI:1063857217
Name:PERRY, GARLAND
Entity Type:Individual
Prefix:
First Name:GARLAND
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5895 NE TRAIL AVE
Mailing Address - Street 2:APT 202
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5985 TRAIL AVE NE
Practice Address - Street 2:APT 202
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-7567
Practice Address - Country:US
Practice Address - Phone:804-605-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit