Provider Demographics
NPI:1124003546
Name:PERRIN, ANTHONY TREVOR (DO, MBA)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:TREVOR
Last Name:PERRIN
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 952816
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-2816
Mailing Address - Country:US
Mailing Address - Phone:407-716-5776
Mailing Address - Fax:321-256-0667
Practice Address - Street 1:1236 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411
Practice Address - Country:US
Practice Address - Phone:561-774-8660
Practice Address - Fax:561-774-8665
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8957207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267359200Medicaid
FL71235YMedicare PIN
FLH95033Medicare UPIN
FL267359200Medicaid