Provider Demographics
NPI:1225182264
Name:PERRA, ROBERT GRAY (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GRAY
Last Name:PERRA
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11081 GREER DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9388
Mailing Address - Country:US
Mailing Address - Phone:269-731-4662
Mailing Address - Fax:269-659-4874
Practice Address - Street 1:103 S 4TH ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1819
Practice Address - Country:US
Practice Address - Phone:269-651-3902
Practice Address - Fax:269-659-4874
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301004082103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI61-41803Medicaid
MI014850OtherCHAMPUS VA
MIM018978OtherTRICARE
MI61-41803Medicaid
MIR67382Medicare UPIN