Provider Demographics
NPI:1093902413
Name:PERRY, CHADWICK JAY (PA C)
Entity Type:Individual
Prefix:MR
First Name:CHADWICK
Middle Name:JAY
Last Name:PERRY
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5615 DUNBARTON AVE
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8216
Mailing Address - Country:US
Mailing Address - Phone:509-222-1275
Mailing Address - Fax:509-491-3031
Practice Address - Street 1:8508 W GAGE BLVD STE A101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8106
Practice Address - Country:US
Practice Address - Phone:509-222-1275
Practice Address - Fax:509-491-3031
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3003PEOtherBSWA
WA8495541Medicaid
WA0225690OtherLIWA
WAG8869032Medicare PIN