Provider Demographics
NPI:1558653501
Name:PERRY FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:PERRY FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:801-668-4860
Mailing Address - Street 1:1030 MEDICAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-3050
Mailing Address - Country:US
Mailing Address - Phone:435-723-4500
Mailing Address - Fax:435-723-4504
Practice Address - Street 1:1030 MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3050
Practice Address - Country:US
Practice Address - Phone:435-723-4500
Practice Address - Fax:435-723-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT277575-4405261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000074157Medicare UPIN