Provider Demographics
NPI:1891913372
Name:PERRYMAN, JENNIFER H (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:PERRYMAN
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 1:6767 29TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-5474
Mailing Address - Country:US
Mailing Address - Phone:970-652-2740
Mailing Address - Fax:970-652-2733
Practice Address - Street 1:6767 29TH ST FL 3
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-5474
Practice Address - Country:US
Practice Address - Phone:970-652-2740
Practice Address - Fax:970-652-2733
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYIP967207N00000X
KY42464207N00000X
IN01067334A207N00000X
CO0056904207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0381309Medicare UPIN
IN265290AMedicare PIN
KY50031701OtherPASSPORT
P00804631OtherRR MEDICARE
KY0381309Medicare UPIN