Provider Demographics
NPI:1649389446
Name:PERRY, JOHN EDWARD III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:PERRY
Suffix:III
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 1:119 N SUMMER CLOUD DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6225
Mailing Address - Country:US
Mailing Address - Phone:832-656-8675
Mailing Address - Fax:
Practice Address - Street 1:3500 W DAVIS ST
Practice Address - Street 2:SUITE 220
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-1849
Practice Address - Country:US
Practice Address - Phone:936-760-1691
Practice Address - Fax:936-760-1693
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1430207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL1430OtherMEDICAL LICENSE NUMBER
TXH31694Medicare UPIN
TX00828WMedicare ID - Type UnspecifiedGROUP NUMBER
TX8B93330Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER