Provider Demographics
NPI:1285664664
Name:PERIC, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:PERIC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2701 W ALAMEDA AVE
Mailing Address - Street 2:SUITE # 504
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4402
Mailing Address - Country:US
Mailing Address - Phone:818-570-0542
Mailing Address - Fax:818-558-1156
Practice Address - Street 1:11333 MOORPARK ST
Practice Address - Street 2:#188
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91602-2618
Practice Address - Country:US
Practice Address - Phone:818-570-0542
Practice Address - Fax:818-558-1156
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CAA79419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-470-102-5OtherECFMG
0-470-102-5OtherECFMG