Provider Demographics
NPI:1629138326
Name:SEGAL, PERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:
Last Name:SEGAL
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 1:250 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4420
Mailing Address - Country:US
Mailing Address - Phone:408-395-1441
Mailing Address - Fax:408-395-1441
Practice Address - Street 1:250 BLOSSOM HILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4420
Practice Address - Country:US
Practice Address - Phone:408-395-1441
Practice Address - Fax:408-395-1441
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC392422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C392420Medicaid
CA00C392420Medicare ID - Type Unspecified
CA00C392420Medicaid