Provider Demographics
NPI:1275505687
Name:PERRY, WENDELL C (MD)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:C
Last Name:PERRY
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 1:555 NE 15TH ST
Mailing Address - Street 2:STE 12D
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132
Mailing Address - Country:US
Mailing Address - Phone:305-864-0013
Mailing Address - Fax:305-864-0634
Practice Address - Street 1:1111 KANE CONCOURSE
Practice Address - Street 2:STE 511
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154
Practice Address - Country:US
Practice Address - Phone:305-864-0013
Practice Address - Fax:305-864-0634
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0081098208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G25217Medicare UPIN
58989Medicare ID - Type Unspecified