Provider Demographics
NPI:1518077486
Name:PERRY, WILLIAM E (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
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 1:480 N FITZMAURICE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6234
Mailing Address - Country:US
Mailing Address - Phone:928-443-7479
Mailing Address - Fax:
Practice Address - Street 1:480 N FITZMAURICE DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-6234
Practice Address - Country:US
Practice Address - Phone:928-443-7479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ286808OtherACCHS
AZ86-1043923OtherAZ FOUNDATION
AZAZ0898770OtherBLUE CROSS BLUE SHIELD
AZ86-1043923OtherUNITED HEALTH
AZD37442Medicare UPIN
AZ69016Medicare ID - Type UnspecifiedINDIVIDUAL
AZ69015Medicare ID - Type UnspecifiedGROUP