Provider Demographics
NPI:1669479366
Name:PERRY, VAN EMMET (MD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:EMMET
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4330 MEDICAL DR
Mailing Address - Street 2:STE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3318
Mailing Address - Country:US
Mailing Address - Phone:210-732-3668
Mailing Address - Fax:210-599-1223
Practice Address - Street 1:2455 NE LOOP 410
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5649
Practice Address - Country:US
Practice Address - Phone:210-659-2635
Practice Address - Fax:210-599-1223
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK9148207N00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB150870OtherWELLMED NETWORKS INC
TX8407B6Medicare PIN
TXB150870OtherWELLMED NETWORKS INC