Provider Demographics
NPI:1639110638
Name:PERRY, MELVIN G JR (MD)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:G
Last Name:PERRY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT 409 PO BOX 4346
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4346
Mailing Address - Country:US
Mailing Address - Phone:210-558-6288
Mailing Address - Fax:210-558-6289
Practice Address - Street 1:520 MADISON OAK DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3913
Practice Address - Country:US
Practice Address - Phone:210-558-6288
Practice Address - Fax:210-558-6289
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI49276-0202080P0203X
TXM95772080P0203X
LA022738208000000X, 2080P0203X
KSO4-306002080P0203X
GA0464702080P0203X
MO20040255272080P0203X
TN400582080P0203X
PA4354562080P0203X
OH35.0834852080P0203X
IN01057110A2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1492574Medicaid
LA1492574Medicaid
LA4M542CQ62Medicare PIN