Provider Demographics
NPI:1124183736
Name:PERCH, GERALD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:ALAN
Last Name:PERCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 OAK COMMON AVE
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-6803
Mailing Address - Country:US
Mailing Address - Phone:904-824-3606
Mailing Address - Fax:904-824-3606
Practice Address - Street 1:287 OAK COMMON AVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-6803
Practice Address - Country:US
Practice Address - Phone:904-824-3606
Practice Address - Fax:904-824-3606
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027389L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D68648Medicare UPIN