Provider Demographics
NPI:1326015470
Name:PERRY R SECOR MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PERRY R SECOR MD MEDICAL CORPORATION
Other - Org Name:LOS ALAMITOS ORTHOPAEDIC MEDICAL AND SURGICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SECOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-314-1400
Mailing Address - Street 1:3851 KATELLA AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3309
Mailing Address - Country:US
Mailing Address - Phone:562-314-1400
Mailing Address - Fax:562-431-0564
Practice Address - Street 1:3851 KATELLA AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3108
Practice Address - Country:US
Practice Address - Phone:562-314-1400
Practice Address - Fax:562-431-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48048207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G480480OtherBLUE SHIELD
CA5347320001Medicare NSC
CAW17035AMedicare ID - Type UnspecifiedGROUP MEDICARE
CAE83325Medicare UPIN