Provider Demographics
NPI:1003010687
Name:PERRI, ANTHONY JOSEPH III (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:PERRI
Suffix:III
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:PO BOX 3265
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3265
Mailing Address - Country:US
Mailing Address - Phone:936-522-4966
Mailing Address - Fax:936-522-4998
Practice Address - Street 1:4015 INTERSTATE 45 N STE 200
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5076
Practice Address - Country:US
Practice Address - Phone:936-522-4966
Practice Address - Fax:936-522-4998
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6826207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197963502Medicaid
TX197963501Medicaid
TX8K9087Medicare PIN