Provider Demographics
NPI:1659376234
Name:PERRY, ROBERT ELVIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELVIE
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 1:343 GRAPHITE LN
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-9148
Mailing Address - Country:US
Mailing Address - Phone:573-651-3259
Mailing Address - Fax:573-332-0206
Practice Address - Street 1:1701 LACEY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5230
Practice Address - Country:US
Practice Address - Phone:573-331-6353
Practice Address - Fax:573-331-6378
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3H52207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202468104Medicaid
MO202468104Medicaid
110231382Medicare ID - Type UnspecifiedRAILROAD MEDICARE #
000095189Medicare ID - Type Unspecified