Provider Demographics
NPI:1164423646
Name:PERRY, BARBARA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 TEXOMA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-3519
Mailing Address - Country:US
Mailing Address - Phone:928-855-7553
Mailing Address - Fax:928-855-7553
Practice Address - Street 1:1979 MCCULLOCH BLVD N
Practice Address - Street 2:SUITE 203
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0953
Practice Address - Country:US
Practice Address - Phone:928-855-7553
Practice Address - Fax:928-855-7553
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ387022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0745800OtherBLUE CROSS
A09079Medicare UPIN
AZZ 77997Medicare ID - Type Unspecified