Provider Demographics
NPI:1073613295
Name:PERRY, NATHAN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:PERRY
Suffix:JR
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 1:1301 MONUMENT RD
Mailing Address - Street 2:SUITE 21
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-7407
Mailing Address - Country:US
Mailing Address - Phone:904-724-9334
Mailing Address - Fax:904-725-3120
Practice Address - Street 1:1301 MONUMENT RD
Practice Address - Street 2:SUITE 21
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-7407
Practice Address - Country:US
Practice Address - Phone:904-724-9334
Practice Address - Fax:904-725-3120
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4618Medicare ID - Type Unspecified
FLF19958Medicare UPIN