Provider Demographics
NPI:1114103926
Name:PERRY, FREDERICK D (DPM)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:D
Last Name:PERRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 ELM RD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-2606
Mailing Address - Country:US
Mailing Address - Phone:330-372-2218
Mailing Address - Fax:330-372-2572
Practice Address - Street 1:2900 ELM RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-2606
Practice Address - Country:US
Practice Address - Phone:330-372-2218
Practice Address - Fax:330-372-2572
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001551213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4231871Medicare PIN
OHT80353Medicare UPIN