Provider Demographics
NPI:1568674984
Name:PERSE, TERI (MD)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:PERSE
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 1:8941 ATLANTA AVE # 328
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7121
Mailing Address - Country:US
Mailing Address - Phone:949-433-4871
Mailing Address - Fax:714-274-9203
Practice Address - Street 1:4616 25TH AVE NE # 509
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4183
Practice Address - Country:US
Practice Address - Phone:206-579-8374
Practice Address - Fax:714-274-9203
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA283472083P0901X
WI253902083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F04584Medicare UPIN