Provider Demographics
NPI:1659322550
Name:PERRY, MAURICE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:A
Last Name:PERRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18039 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4630
Mailing Address - Country:US
Mailing Address - Phone:818-708-8100
Mailing Address - Fax:
Practice Address - Street 1:18039 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4630
Practice Address - Country:US
Practice Address - Phone:818-708-8100
Practice Address - Fax:818-705-8818
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWE3859A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10980Medicare PIN
CAWE3859BMedicare PIN
CAW8424Medicare PIN
DE687AMedicare PIN
CAU37026Medicare UPIN