Provider Demographics
NPI:1518057439
Name:PERRIN, DAVEY M (MD)
Entity Type:Individual
Prefix:
First Name:DAVEY
Middle Name:M
Last Name:PERRIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S CLAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4530
Mailing Address - Country:US
Mailing Address - Phone:903-229-4292
Mailing Address - Fax:903-229-4288
Practice Address - Street 1:206 S CLAY ST STE A
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4530
Practice Address - Country:US
Practice Address - Phone:903-229-4292
Practice Address - Fax:903-229-4288
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086588207Q00000X
TXN4662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301086588OtherSTATE LICENSE