Provider Demographics
NPI:1114924594
Name:PERRY, DONALD THOMAS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:THOMAS
Last Name:PERRY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9423 VALLEY VIEW TRL
Mailing Address - Street 2:FISHERMANS PARADISE
Mailing Address - City:RIO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:76093-3102
Mailing Address - Country:US
Mailing Address - Phone:817-556-9907
Mailing Address - Fax:
Practice Address - Street 1:705 E GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-3135
Practice Address - Country:US
Practice Address - Phone:940-872-9404
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX026602367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered