Provider Demographics
NPI:1548237795
Name:SECOR, PERRY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:ROBERT
Last Name:SECOR
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 1:3851 KATELLA AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3353
Mailing Address - Country:US
Mailing Address - Phone:562-314-1400
Mailing Address - Fax:562-431-0564
Practice Address - Street 1:3851 KATELLA AVE STE 150
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3353
Practice Address - Country:US
Practice Address - Phone:562-314-1400
Practice Address - Fax:562-431-0564
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48048207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG480480OtherBLUE SHIELD PROVIDER #
CAWG48048FMedicare ID - Type UnspecifiedINDIV MEDICARE NUMBER
CAOOG480480OtherBLUE SHIELD PROVIDER #