Provider Demographics
NPI:1710050729
Name:PERRY, JAMI T (MD)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:T
Last Name:PERRY
Suffix:
Gender:F
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:42450-0037
Mailing Address - Country:US
Mailing Address - Phone:270-667-7017
Mailing Address - Fax:270-667-9065
Practice Address - Street 1:215 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:KY
Practice Address - Zip Code:42450-1261
Practice Address - Country:US
Practice Address - Phone:270-667-7017
Practice Address - Fax:270-667-9065
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY41202OtherKY STATE LICENCE
0745826Medicare PIN
0952011Medicare PIN
0903680Medicare PIN
0935386Medicare PIN
00151006Medicare PIN
KY41202OtherKY STATE LICENCE
0396857Medicare PIN
KYK034541Medicare PIN
0771919Medicare PIN
0683239Medicare PIN
0935811Medicare PIN