Provider Demographics
NPI:1568402808
Name:PERRY, REBECCA S (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:S
Last Name:PERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 BELLEVILLE LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5502
Mailing Address - Country:US
Mailing Address - Phone:937-432-0574
Mailing Address - Fax:
Practice Address - Street 1:1000 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8330
Practice Address - Country:US
Practice Address - Phone:513-932-8171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006219207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000543487OtherANTHEM BCBS
P00034012OtherRAIL ROAD MEDICARE
OH000000317052OtherANTHEM BCBS
000000302737OtherBCBS
OH0338781Medicaid
OH000000326510OtherANTHEM/BCBS
OH000000531798OtherANTHEM BCBS
OH000000326510OtherANTHEM/BCBS
OH0819249Medicare PIN
P00034012OtherRAIL ROAD MEDICARE
PE0819248Medicare PIN
OH000000543487OtherANTHEM BCBS
OH4162083Medicare PIN