Provider Demographics
NPI:1689687360
Name:PERRY, RICHARD JAY (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:PERRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-0249
Mailing Address - Country:US
Mailing Address - Phone:940-458-4774
Mailing Address - Fax:940-458-0212
Practice Address - Street 1:1630 W CHAPMAN DR
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266
Practice Address - Country:US
Practice Address - Phone:940-458-4774
Practice Address - Fax:940-458-0212
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE85853Medicare UPIN
TX00G01VMedicare PIN