Provider Demographics
NPI:1245218510
Name:PERRY, ARCHIE CHARLES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARCHIE
Middle Name:CHARLES
Last Name:PERRY
Suffix:JR
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 1:2800 E DESERT INN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3609
Mailing Address - Country:US
Mailing Address - Phone:702-731-1616
Mailing Address - Fax:702-734-4900
Practice Address - Street 1:2800 E DESERT INN RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3609
Practice Address - Country:US
Practice Address - Phone:702-731-1616
Practice Address - Fax:702-734-4900
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV42033207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC6778OtherBXBS
7499443OtherAETNA
NV1245218510Medicaid
P00142405OtherR.R. MEDICARE
NVV39306Medicare PIN
P00142405OtherR.R. MEDICARE