Provider Demographics
NPI:1346471216
Name:PERRY, LAURA LUISA (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LUISA
Last Name:PERRY
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WEST LOSEY DR
Mailing Address - Street 2:SCOTT AFB,
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:62225
Mailing Address - Country:US
Mailing Address - Phone:618-256-7506
Mailing Address - Fax:
Practice Address - Street 1:4881 SUGAR MAPLE DR
Practice Address - Street 2:WRIGHT PATTERSON AFB, OH
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45433-5546
Practice Address - Country:US
Practice Address - Phone:937-904-1058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians