Provider Demographics
NPI:1326286279
Name:MALCOLM O PERRY III MD PA
Entity Type:Organization
Organization Name:MALCOLM O PERRY III MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:O
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:469-854-6116
Mailing Address - Street 1:1111 RAINTREE CIR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4901
Mailing Address - Country:US
Mailing Address - Phone:469-854-6116
Mailing Address - Fax:469-854-6399
Practice Address - Street 1:1111 RAINTREE CIR
Practice Address - Street 2:SUITE 240
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4901
Practice Address - Country:US
Practice Address - Phone:469-854-6116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1476208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3431Medicare PIN