Provider Demographics
NPI:1548226863
Name:PERRY, BARBARA GENNICE (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:GENNICE
Last Name:PERRY
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 1:12300 CHENAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2724
Mailing Address - Country:US
Mailing Address - Phone:501-225-6054
Mailing Address - Fax:501-225-6067
Practice Address - Street 1:12300 CHENAL PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2724
Practice Address - Country:US
Practice Address - Phone:501-225-6054
Practice Address - Fax:501-225-6067
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M793OtherMEDICARE
ARI02798OtherUPIN
AR154228001Medicaid