Provider Demographics
NPI:1710072269
Name:PERRY, RADIE FLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:RADIE
Middle Name:FLOYD
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 1:8220 WALNUT HILL LN
Mailing Address - Street 2:SUITE 508
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4427
Mailing Address - Country:US
Mailing Address - Phone:214-691-6029
Mailing Address - Fax:214-373-6857
Practice Address - Street 1:8220 WALNUT HILL LN
Practice Address - Street 2:SUITE 508
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4427
Practice Address - Country:US
Practice Address - Phone:214-691-6029
Practice Address - Fax:214-373-6857
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6753208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX109408802Medicaid
TX4140238OtherAETNA
TX88T402OtherBLUE CROSS
TX122503904Medicaid
TX8559K0OtherMEDICARE
TX2839522003OtherCIGNA
TX2839522003OtherCIGNA