Provider Demographics
NPI:1639438633
Name:A W PERRY JR M D A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:A W PERRY JR M D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:818-790-0385
Mailing Address - Street 1:1808 VERDUGO BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1477
Mailing Address - Country:US
Mailing Address - Phone:818-790-0385
Mailing Address - Fax:818-790-4153
Practice Address - Street 1:1808 VERDUGO BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1477
Practice Address - Country:US
Practice Address - Phone:818-790-0385
Practice Address - Fax:818-790-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43094208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE02651Medicare UPIN