Provider Demographics
NPI:1629170956
Name:PERRY, ROD W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROD
Middle Name:W
Last Name:PERRY
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 1:365 HAWTHORNE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3114
Mailing Address - Country:US
Mailing Address - Phone:510-419-0211
Mailing Address - Fax:510-419-0140
Practice Address - Street 1:365 HAWTHORNE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3114
Practice Address - Country:US
Practice Address - Phone:510-419-0211
Practice Address - Fax:510-419-0140
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45722Medicare UPIN
CAZZZ70089ZMedicare ID - Type Unspecified