Provider Demographics
NPI:1497756688
Name:PERRY, DWIGHT DEAN (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:DEAN
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 N ROXBORO RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704
Mailing Address - Country:US
Mailing Address - Phone:919-595-2000
Mailing Address - Fax:
Practice Address - Street 1:4102 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2122
Practice Address - Country:US
Practice Address - Phone:919-595-2000
Practice Address - Fax:919-595-2190
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28678207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC355036OtherMAMSI
NC10313OtherOPTICARE
NC66871OtherBCBS NC
NC8966871Medicaid
NC4309810OtherAETNA
NC91237OtherMEDCOST
NC0855501OtherUNITED HEALTHCARE
NC56128876721OtherCIGNA
NC203479FMedicare ID - Type UnspecifiedCIGNA
C81876Medicare UPIN