Provider Demographics
NPI:1104828961
Name:PERRY, DEBRA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANNE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANNE
Other - Last Name:CARBONARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:2240 SUTHERLAND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-2333
Practice Address - Country:US
Practice Address - Phone:865-909-0090
Practice Address - Fax:865-909-9883
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9837207R00000X
TN51980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RE7915Medicare PIN
020350051OtherFEDERAL TAX ID#
NH3626045001OtherCIGNA HEALTHCARE
NH80013818Medicaid
110226843Medicare PIN
NH9837OtherSTATE LICENSE #
NH3072594Medicaid
NH0109125YPNH02OtherANTHEM BC/BS
BP3666217OtherFEDERAL DEA#
P00100694OtherRAILROAD MEDICARE
RE2728Medicare PIN