Provider Demographics
NPI:1679637920
Name:PERRY, JOHN CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTIAN
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 1:4309 W 27TH PL STE 200
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2908
Mailing Address - Country:US
Mailing Address - Phone:509-582-0400
Mailing Address - Fax:509-582-0408
Practice Address - Street 1:4309 W 27TH PL STE 200
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2908
Practice Address - Country:US
Practice Address - Phone:509-582-0400
Practice Address - Fax:509-582-0408
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA25747207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA07796Medicare UPIN