Provider Demographics
NPI:1710093497
Name:PERRY, CYNTHIA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANNE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 W WALKER ST
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:76424-4000
Mailing Address - Country:US
Mailing Address - Phone:254-559-7215
Mailing Address - Fax:254-559-7213
Practice Address - Street 1:2802 W WALKER ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424-4000
Practice Address - Country:US
Practice Address - Phone:254-559-7215
Practice Address - Fax:254-559-7213
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX29401902Medicaid
TX29401902Medicaid