Provider Demographics
NPI:1376813584
Name:DR. GARY R. PERRIN, P.A.
Entity Type:Organization
Organization Name:DR. GARY R. PERRIN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:PERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP
Authorized Official - Phone:612-317-0665
Mailing Address - Street 1:527 MARQUETTE AVE
Mailing Address - Street 2:STE. 1620
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-1302
Mailing Address - Country:US
Mailing Address - Phone:612-317-0665
Mailing Address - Fax:612-317-1017
Practice Address - Street 1:527 MARQUETTE AVE
Practice Address - Street 2:STE. 1620
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-1302
Practice Address - Country:US
Practice Address - Phone:612-317-0665
Practice Address - Fax:612-317-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 305251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health