Provider Demographics
NPI:1982212593
Name:DAVID PERSE MD, LLC
Entity Type:Organization
Organization Name:DAVID PERSE MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:PERSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-363-7402
Mailing Address - Street 1:PO BOX 771545
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-0061
Mailing Address - Country:US
Mailing Address - Phone:216-363-7402
Mailing Address - Fax:216-363-2796
Practice Address - Street 1:2401 SCRANTON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-4313
Practice Address - Country:US
Practice Address - Phone:216-363-7402
Practice Address - Fax:216-363-2796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty